Pioglitazone and bariatric surgery are the most effective treatments for non?alcoholic steatohepatitis: A hierarchical network meta?analysis

Aims To compare different treatments for non-alcoholic steatohepatitis (NASH) and to determine an effectiveness hierarchy. Materials Methods We conducted a systematic review Bayesian network meta-analysis including randomized controlled trials or prospective with at least 6 months' follow-up histologically proven NASH in adult participants. Monte Carlo simulations were performed, each generating 10 000 data points, results are reported as medians 95% credibility intervals (CrIs). A meta-regression was find the effects of body mass index (BMI) decrement reduction homeostatic model assessment insulin resistance (HOMA-IR) on fatty liver disease activity score (NAS) change. Results The identified 48 eligible comprising 2356 adults (55.6% men). Data pooled using random-effects model. most effective terms NAS per semester pioglitazone Roux-en-Y gastric bypass (RYGB; ?1.50 [95% CrI ?2.08, ?1.00] pioglitazione ?1.00 ?1.70, ?0.32] RYGB). Pioglitazone also best therapy steatosis lobular inflammation reduction. RYGB treatment hepatocellular ballooning reduction, whereas antioxidants appeared be fibrosis improvement. For 1% BMI, reduced by 1.3% (? = 1.28%, P 0.01). Conversely, HOMA-IR 0.3% 0.31%, < 0.001). Treatments that regarded promising, such elafibranor, simtuzumab, selonsertib, cenicriviroc, obeticholic acid liraglutide, did not reduce either significantly. Conclusions Pioglitazione therapies NASH. Antioxidants may reducing fibrosis. Weight loss improvement hepatic promising approaches