Meta-analysis: Efficacy of Pioglitazone and Metformin in the Treatment of Nonalcoholic Steatohepatitis Open Access

Abstract

Background: This meta-analysis investigates the efficacy of pioglitazone and metformin in the
treatment of nonalcoholic steatohepatitis (NASH). A recent meta-analysis demonstrated efficacy
of pioglitazone, but found no benefit with metformin in the treatment of NASH. The outcome
measures in that study were expressed as any improvement (yes versus no) regardless of
magnitude. Using a different methodology that considers continuous outcome measures we set
out to determine if the results of our meta-analysis and the one published previously arrive at
similar or different conclusions.
Methods: Multiple online databases were searched and reports of randomized controlled trials
reviewed. The summary results were expressed as meta-differences for continuous endpoints of
histology and liver function tests. All summary measures of effect were calculated using fixed
and random effects models accompanied by a corresponding 95% confidence interval (CI) and a
test for heterogeneity.
Results: None of the random effects models demonstrated a statistically significant departure
from the null for pioglitazone, ALT (meta-DD, 3.17; 95% CI: -17.46, 23.81), AST (meta-DD, -
7.03; 95% CI: -28.71, 14.65) or metformin, ALT (meta-DD, 6.02; 95% CI: -8.84, 20.87), AST
(meta-DD, 5.20; 95% CI: -5.34, 15.73). Similarly, pioglitazone use was not associated with
improvement in any of the histological parameters: steatosis (meta-DD, -0.03; 95% CI: -0.62,
0.55), inflammation (meta-DD, -0.16; 95% CI: -0.62, 0.30), ballooning (meta-DD, 0.04; 95% CI:
-0.33, 0.41), fibrosis (meta-DD, 0.17; 95% CI: -0.15, 0.49).
Conclusions: Unlike the previously published meta-analysis, our results do not favor the use of
pioglitazone or metformin for the treatment of NASH. The different conclusions drawn from the
two meta-analyses are likely attributable to variations in analytic techniques.

Meta-analysis: Efficacy of Pioglitazone and Metformin in the Treatment of Nonalcoholic
Steatohepatitis

M.D., University of Lagos, Nigeria, 1992
Thesis Committee Chair: Michael Goodman, MD
An abstract of
A thesis submitted to the Faculty of the
Rollins School of Public Health of Emory University
in partial fulfillment of the requirements for the degree of
Master of Public Health
in Epidemiology
2012

Table of Contents

Introduction........Page 1

Methods..............Page 3

Results............Page 7

Discussion........Page 9

References........Page 13

Tables and contents...Page 15

About this Master's Thesis

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	Nonalcoholic steatohepatitis NASH
Committee Chair / Thesis Advisor	Goodman, Michael, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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