Systematic review and meta-analysis: analysis of variables influencing the interpretation of clinical trial results in NAFLD

• Published in: Journal of gastroenterology 2022-05, Vol.57 (5), p.357-371
• Main Authors: Ampuero, Javier, Gallego-Durán, Rocío, Maya-Miles, Douglas, Montero, Rocío, Gato, Sheila, Rojas, Ángela, Gil, Antonio, Muñoz, Rocío, Romero-Gómez, Manuel
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Antidiabetics; Biliary Tract; Biopsy; Cirrhosis; Clinical trials; Colorectal Surgery; Diabetes mellitus; Drug development; Fibrosis; Gastroenterology; Hepatology; Humans; Hypoglycemic Agents - therapeutic use; Liver; Liver cirrhosis; Liver Cirrhosis - pathology; Medicine; Medicine & Public Health; Meta-analysis; Non-alcoholic Fatty Liver Disease - pathology; Original Article—Liver; Original —Liver, Pancreas, and Biliary Tract; Pancreas; Peroxisome proliferator-activated receptors; Placebos; Sensitivity analysis; Surgical Oncology; Systematic review
• ISSN: 0944-1174; 1435-5922
• DOI: 10.1007/s00535-022-01860-0

Background NAFLD clinical trials have shown suboptimal results, particularly for liver fibrosis, despite the robust preclinical drug development. We aimed to assess the histological response after the experimental treatment versus placebo by carrying out a meta-analysis of NAFLD clinical trials. Methods After a systematic review of NAFLD clinical trials to May 2021, applying strict selection criteria, the following primary outcomes were observed: (a) NASH resolution, with no worsening of fibrosis when available; (b) fibrosis improvement  ≥ 1 stage, with no worsening of NAS when available; (c) worsening of NAS; (d) worsening of liver fibrosis  ≥ 1 stage, including the progression to cirrhosis on histopathology. Other histological, clinical, and biochemical outcomes were considered secondary endpoints. Heterogeneity was explored by subgroup and sensitivity analyses, and univariable meta-regression. Results Twenty-seven randomized clinical trials were included. The pooled efficacy for NASH resolution receiving experimental therapy was 19% (95%CI 15–23; I 2 96.2%) compared with placebo 10% (95%CI 7–12; I 2 85.8%) (OR 1.66 (95%CI 1.24–2.21); I 2 57.8%), while it was 26% (95%CI 22–29); I 2 90%)) versus 18% (95%CI 15–21; I 2 59%)) for fibrosis improvement (OR 1.34 (95%CI 1.13–1.58); I 2 25.4%). For these outcomes, the therapy showed higher efficacy in trials longer than 48 weeks, with