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Empagliflozin most effectively reduces liver stiffness, while liraglutide shows the greatest benefits in body weight and metabolic parameters in adults with MASLD.
A new network meta-analysis has revealed that among various hypoglycemic agents, empagliflozin and liraglutide stand out as the most promising treatments for metabolic dysfunction-associated steatotic liver disease (MASLD). The study, which analyzed data from 37 randomized clinical trials (RCTs) involving 2,406 volunteers, was designed to compare the effectiveness of 26 hypoglycemic agents in MASLD.
Researchers conducted an extensive search across 7 databases, including PubMed, Embase, CNKI, and the Cochrane Library. Statistical analysis was performed using R software, and the network meta-analysis was carried out via Bayesian modeling to establish a comparative framework. Among the findings, empagliflozin, a sodium-glucose co-transporter 2 (SGLT-2) inhibitor, stood out as the most beneficial agent for improving liver stiffness measurement, a key imaging marker for liver fibrosis. Meanwhile, liraglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, showed superior effects in decreasing body weight, body mass index (BMI), and waist circumference.
Both empagliflozin and liraglutide illustrated considerable benefits in improving liver enzymes—including alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyltransferase (GGT)—as well as glucose metabolism (fasting plasma glucose and Homeostatic Model Assessment for Insulin Resistance [HOMA-IR]) and lipid profiles. In contrast, pioglitazone offered only limited improvements across these indicators. Inflammatory markers and fibrosis-related outcomes exhibited minimal changes regardless of the intervention.
The study concludes that while hypoglycemic agents can remarkably improve laboratory and imaging markers in MASLD, their effects vary across different metabolic and hepatic parameters. Liraglutide appears most beneficial for metabolic markers, while empagliflozin excels in decreasing liver stiffness. These findings highlight the importance of tailoring therapy based on individual patient profiles and treatment goals.
Journal of Evidence‐Based Medicine
Efficacy of Hypoglycemic Agents in Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD): A Systematic Review and Network Meta-Analysis
Qiao Ren et al.
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