Cargando…

Thiazolidinediones for nonalcoholic steatohepatitis: A meta-analysis of randomized clinical trials

The findings regarding the effects of thiazolidinediones (TZDs) in nonalcoholic steatohepatitis (NASH) patients have been inconsistent, and the assessment of different clinical variables for evaluating the effects of TZDs confound a direct comparison of the results of different randomized clinical t...

Descripción completa

Detalles Bibliográficos
Autores principales: He, Lingling, Liu, Xiaoli, Wang, Lijia, Yang, Zhiyun
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5079311/
https://www.ncbi.nlm.nih.gov/pubmed/27759627
http://dx.doi.org/10.1097/MD.0000000000004947
_version_ 1782462541043073024
author He, Lingling
Liu, Xiaoli
Wang, Lijia
Yang, Zhiyun
author_facet He, Lingling
Liu, Xiaoli
Wang, Lijia
Yang, Zhiyun
author_sort He, Lingling
collection PubMed
description The findings regarding the effects of thiazolidinediones (TZDs) in nonalcoholic steatohepatitis (NASH) patients have been inconsistent, and the assessment of different clinical variables for evaluating the effects of TZDs confound a direct comparison of the results of different randomized clinical trials (RCTs), especially with regard to lifestyle changes. In this paper, we performed a meta-analysis of randomized controlled trials to clarify the effects of TZD treatment with and without lifestyle changes on histological markers of NASH and clinical variables related to insulin resistance (IR), hyperlipidemia, and obesity. We searched the literature using the following MeSH terms: “nonalcoholic steatohepatitis,” “non-alcoholic steatohepatitis,” “thiazolidinedione,” “pioglitazone,” “rosiglitazone,” “randomized,” and “clinical trial.” Five eligible RCTs were selected, in which patients were treated with either pioglitazone or rosiglitazone, with or without lifestyle changes. We compared the effects of TZD treatment on hepatic fibrosis, lobular inflammation, IR improvement, fasting serum insulin, adiposity, and dyslipidemia between the various studies using fixed and random effects models, and heterogeneity in clinical outcomes was assessed. Significant improvement in hepatic fibrosis did not occur among the patients treated with TZDs alone or in those who underwent both lifestyle changes and TZD therapy. Lobular inflammation decreased in NASH patients who received TZD treatment and in those who underwent both TZD therapy and lifestyle changes. Although TZD treatment resulted in no significant improvement in IR, NASH patients who underwent both lifestyle changes and TZD therapy experienced a significantly greater reduction in their fasting insulin level than that observed in the control patients, whereas patients treated with TZDs alone did not. Although TZD-treated patients experienced significantly greater weight gain than the control patients, TZD treatment had no significant impact on body-mass index, percentage of body fat, or serum levels of cholesterol and triglyceride. Our findings indicate that additional variables should be assessed to obtain a more comprehensive evaluation of the effects of TZD treatment on IR and comorbidity risk factors in NASH patients, and suggest that including lifestyle changes and additional insulin-sensitizing agents in TZD regimens might improve the benefits of TZD therapy for NASH.
format Online
Article
Text
id pubmed-5079311
institution National Center for Biotechnology Information
language English
publishDate 2016
publisher Wolters Kluwer Health
record_format MEDLINE/PubMed
spelling pubmed-50793112016-11-03 Thiazolidinediones for nonalcoholic steatohepatitis: A meta-analysis of randomized clinical trials He, Lingling Liu, Xiaoli Wang, Lijia Yang, Zhiyun Medicine (Baltimore) 4200 The findings regarding the effects of thiazolidinediones (TZDs) in nonalcoholic steatohepatitis (NASH) patients have been inconsistent, and the assessment of different clinical variables for evaluating the effects of TZDs confound a direct comparison of the results of different randomized clinical trials (RCTs), especially with regard to lifestyle changes. In this paper, we performed a meta-analysis of randomized controlled trials to clarify the effects of TZD treatment with and without lifestyle changes on histological markers of NASH and clinical variables related to insulin resistance (IR), hyperlipidemia, and obesity. We searched the literature using the following MeSH terms: “nonalcoholic steatohepatitis,” “non-alcoholic steatohepatitis,” “thiazolidinedione,” “pioglitazone,” “rosiglitazone,” “randomized,” and “clinical trial.” Five eligible RCTs were selected, in which patients were treated with either pioglitazone or rosiglitazone, with or without lifestyle changes. We compared the effects of TZD treatment on hepatic fibrosis, lobular inflammation, IR improvement, fasting serum insulin, adiposity, and dyslipidemia between the various studies using fixed and random effects models, and heterogeneity in clinical outcomes was assessed. Significant improvement in hepatic fibrosis did not occur among the patients treated with TZDs alone or in those who underwent both lifestyle changes and TZD therapy. Lobular inflammation decreased in NASH patients who received TZD treatment and in those who underwent both TZD therapy and lifestyle changes. Although TZD treatment resulted in no significant improvement in IR, NASH patients who underwent both lifestyle changes and TZD therapy experienced a significantly greater reduction in their fasting insulin level than that observed in the control patients, whereas patients treated with TZDs alone did not. Although TZD-treated patients experienced significantly greater weight gain than the control patients, TZD treatment had no significant impact on body-mass index, percentage of body fat, or serum levels of cholesterol and triglyceride. Our findings indicate that additional variables should be assessed to obtain a more comprehensive evaluation of the effects of TZD treatment on IR and comorbidity risk factors in NASH patients, and suggest that including lifestyle changes and additional insulin-sensitizing agents in TZD regimens might improve the benefits of TZD therapy for NASH. Wolters Kluwer Health 2016-10-21 /pmc/articles/PMC5079311/ /pubmed/27759627 http://dx.doi.org/10.1097/MD.0000000000004947 Text en Copyright © 2016 the Author(s). Published by Wolters Kluwer Health, Inc. All rights reserved. http://creativecommons.org/licenses/by/4.0 This is an open access article distributed under the Creative Commons Attribution License 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0
spellingShingle 4200
He, Lingling
Liu, Xiaoli
Wang, Lijia
Yang, Zhiyun
Thiazolidinediones for nonalcoholic steatohepatitis: A meta-analysis of randomized clinical trials
title Thiazolidinediones for nonalcoholic steatohepatitis: A meta-analysis of randomized clinical trials
title_full Thiazolidinediones for nonalcoholic steatohepatitis: A meta-analysis of randomized clinical trials
title_fullStr Thiazolidinediones for nonalcoholic steatohepatitis: A meta-analysis of randomized clinical trials
title_full_unstemmed Thiazolidinediones for nonalcoholic steatohepatitis: A meta-analysis of randomized clinical trials
title_short Thiazolidinediones for nonalcoholic steatohepatitis: A meta-analysis of randomized clinical trials
title_sort thiazolidinediones for nonalcoholic steatohepatitis: a meta-analysis of randomized clinical trials
topic 4200
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5079311/
https://www.ncbi.nlm.nih.gov/pubmed/27759627
http://dx.doi.org/10.1097/MD.0000000000004947
work_keys_str_mv AT helingling thiazolidinedionesfornonalcoholicsteatohepatitisametaanalysisofrandomizedclinicaltrials
AT liuxiaoli thiazolidinedionesfornonalcoholicsteatohepatitisametaanalysisofrandomizedclinicaltrials
AT wanglijia thiazolidinedionesfornonalcoholicsteatohepatitisametaanalysisofrandomizedclinicaltrials
AT yangzhiyun thiazolidinedionesfornonalcoholicsteatohepatitisametaanalysisofrandomizedclinicaltrials