COMPARATIVE EFFECTIVENESS OF INTERVENTIONS ON NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD)- A SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS
Author(s)
Sawangjit R1, Chongmelaxme B2, Phisalprapa P3, Saokaew S4, Thakkinstian A3, Kowdley K5, Chaiyakunapruk N6
1Mahasarakham University, Muang, Thailand, 2Naresuan University, Phitsanulok, Thailand, 3Mahidol University, Bangkok, Thailand, 4University of Phayao, Muang, Phayao, Thailand, 5Swedish Medical Center, Seattle, WA, USA, 6Monash University Malaysia, Selangor, Malaysia
OBJECTIVES: The prevalence of non-alcoholic fatty liver disease (NAFLD) has increased over the last decades. Several treatment options have been studied but a lack of concensus of the effective therapy. This study aims to determine comparative effectiveness of interventions for treatment of NAFLD METHODS: We performed a systematic review and network meta-analysis of randomized trials comparing efficacy of all possible treatment regimens in NAFLD. Electronic databases (e.g., Pubmed, Embase, CENTRAL etc.) were searched up to 15/11/2015. Outcomes were fibrosis improvement, changes/improvements of liver histology, all-cause mortality, cirrhosis and safety. A network meta-analysis was applied to estimate pooled risk ratios (RR) or weighted mean differences (WMD) for dichotomous and continuous outcomes. Treatment regimens were then ranked using surface under the cumulative ranking (SUCRA) probabilities. Quality of evidence was assessed using GRADE criteria RESULTS: A total of 44 studies (n= 3,802) were eligible. Obeticholic acid (OCA) was the only intervention that significantly improved fibrosis (RR: 1.91, 95%CI; 1.15- 3.16). Pentoxyfylline (PTX) and thiazolidinedione (TZD) plus metformin were ranked as the most effective treatments for improving fibrosis but they were not statistically significant (RRs (95% CI) = 2.27 (0.81-6.36), and 1.52 (0.79- 2.94), respectively). OCA was also effective for improvement of NAS, steatosis, ballooning, and inflammation with RR (95%CI) of 2.19 (1.42, 3.38), 1.69 (1.24, 4.76), 1.58 (1.06, 2.34), 1.60 (1.02, 2.50), respectively. TZDs and vitamin E were significantly effective in resolution of NASH, NAS improvement, steatosis, and ballooning. Quality of evidence ranged from very low (i.e., metformin, PTX on mean change of ballooning grade) to high (OCA, TZD, vitamin E on improving various histological outcomes) CONCLUSIONS: Our study suggests potential efficacy of several therapeutic agents in improving histologic endpoints in NAFLD. These findings are however based on a small number of studies and additional studies are awaited to strengthen this network meta-analysis
Conference/Value in Health Info
2016-09, ISPOR Asia Pacific 2016, Singapore
Value in Health, Vol. 19, No. 7 (November 2016)
Code
PSY2
Topic
Clinical Outcomes
Topic Subcategory
Comparative Effectiveness or Efficacy
Disease
Diabetes/Endocrine/Metabolic Disorders