| Meta-analysis: insulin sensitizers for the treatment of non-alcoholic steatohepatitis. | |
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MedLine Citation:
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PMID: 20955440 Owner: NLM Status: In-Process |
Abstract/OtherAbstract:
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BACKGROUND: Non-alcoholic fatty liver disease generally has a benign course; however, patients with non-alcoholic steatohepatitis (NASH) may progress to cirrhosis and hepatocellular carcinoma. Currently, there is a lack of consensus about optimal NASH treatment. AIM: To assess the efficacy of insulin-sensitizing agents on histological and biochemical outcomes in randomized control trials of biopsy-proven NASH. METHODS: Multiple online databases and conference abstracts were searched. Random effects meta-analyses were performed, with assessment for heterogeneity and publication bias. RESULTS: Nine trials were included; five trials using thiazolidinediones (glitazones), three using metformin and one trial using both drugs. There was no publication bias. Compared with controls, glitazones resulted in improved steatosis (WMD = 0.57, 95% CI 0.36-0.77, P = <0.001), hepatocyte ballooning (WMD = 0.36, 95% CI 0.24-0.49, P < 0.001) and ALT (WMD = 16.4, 95% CI 7.7-25.0, P < 0.001), but not inflammation (P = 0.09) or fibrosis (P = 0.11). In patients without diabetes, glitazones significantly improved all histological and biochemical outcomes, most importantly including fibrosis (WMD = 0.29, 95% CI 0.078-0.51, P = 0.008). Metformin failed to improve any pooled outcome. CONCLUSIONS: Treatment of NASH with glitazones, but not metformin, demonstrates a significant histological and biochemical benefit, especially in patients without diabetes. Additional studies are needed to investigate long-term outcomes of glitazone therapy in patients without diabetes. |
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Authors:
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M O Rakoski; A G Singal; M A M Rogers; H Conjeevaram |
Publication Detail:
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Type: Journal Article; Meta-Analysis Date: 2010-09-23 |
Journal Detail:
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Title: Alimentary pharmacology & therapeutics Volume: 32 ISSN: 1365-2036 ISO Abbreviation: Aliment. Pharmacol. Ther. Publication Date: 2010 Nov |
Date Detail:
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Created Date: 2010-10-19 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8707234 Medline TA: Aliment Pharmacol Ther Country: England |
Other Details:
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Languages: eng Pagination: 1211-21 Citation Subset: IM |
Copyright Information:
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© 2010 Blackwell Publishing Ltd. |
Affiliation:
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Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, USA. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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