In the Journals

Vitamin E, TZDs, OCA help patients with NASH

Vitamin E, thiazolidinediones and obeticholic acid improved ballooning degeneration in patients with nonalcoholic steatohepatitis, according to a meta-analysis in Hepatology. In addition, pentoxifylline and obeticholic acid were found to improve liver fibrosis and thiazolidinediones, pentoxifylline and obeticholic acid improved steatosis and lobular inflammation.

“We made several key observations: (1) pentoxifylline and [obeticholic acid] are superior to placebo for improving fibrosis, with moderate confidence in estimates; (2) vitamin E, [thiazolidinediones] and [obeticholic acid] are superior to placebo for improving ballooning degeneration, with high confidence in estimates; and (3) [thiazolidinediones], pentoxifylline and [obeticholic acid] are superior to placebo for improving steatosis and lobular inflammation, with at least moderate confidence in estimates,” Siddharth Singh, of the Mayo Clinic, in Rochester, Minn., and colleagues wrote.

Singh and colleagues performed a systematic literature review and found nine randomized controlled trials (n = 964) that compared using either vitamin E, thiazolidinediones (TZDs), pentoxifylline or obeticholic acid (OCA) in 964 patients with NASH. The primary outcome was improvement in fibrosis stage. In addition, the researchers assessed for relative risks and 95% credible intervals from Bayesian network meta-analysis and used Grading of Recommendations Assessment, Development and Evaluation criteria to determine the quality of the evidence. Mean age of the patients in the studies ranged from 45 to 53 years and 30% to 69% were men.

For balloon degeneration, the researchers found that vitamin E (RR = 0.73; 95% CI, 0.61-0.86), TZDs (RR = 0.81; 95% CI, 0.71-0.93) and OCA (RR = 0.75; 95% CI, 0.65-0.96) were associated with improvement compared to placebo. For liver fibrosis, they found that pentoxifylline (RR = 0.8; 95% CI, 0.65-0.98) and OCA (RR = 0.81; 95% CI, 0.7-0.95) showed the most improvement compared to placebo. For steatosis, they found that TZDs (RR = 0.62; 95% CI, 0.46-0.83), pentoxifylline (RR = 0.61; 95% CI, 0.4-0.92) and OCA (RR = 0.66; 95% CI, 0.51-0.85) had more improvement compared to placebo. In addition, for lobular inflammation, TZDs (RR = 0.63; 95% CI, 0.47-0.85), pentoxifylline (RR = 0.71; 95% CI, 0.54-0.94) and OCA (RR = 0.74; 95% CI, 0.59-0.92) showed more improvement than placebo.

 “Using network meta-analysis, we observed that pentoxifylline, TZDs, and vitamin E are superior to placebo and comparable to one another for improving key histological features of NASH,” Singh and colleagues wrote. “OCA also appears promising, though additional data are warranted.” – by Will Offit

Disclosures: The researchers report no relevant financial disclosures.

Vitamin E, thiazolidinediones and obeticholic acid improved ballooning degeneration in patients with nonalcoholic steatohepatitis, according to a meta-analysis in Hepatology. In addition, pentoxifylline and obeticholic acid were found to improve liver fibrosis and thiazolidinediones, pentoxifylline and obeticholic acid improved steatosis and lobular inflammation.

“We made several key observations: (1) pentoxifylline and [obeticholic acid] are superior to placebo for improving fibrosis, with moderate confidence in estimates; (2) vitamin E, [thiazolidinediones] and [obeticholic acid] are superior to placebo for improving ballooning degeneration, with high confidence in estimates; and (3) [thiazolidinediones], pentoxifylline and [obeticholic acid] are superior to placebo for improving steatosis and lobular inflammation, with at least moderate confidence in estimates,” Siddharth Singh, of the Mayo Clinic, in Rochester, Minn., and colleagues wrote.

Singh and colleagues performed a systematic literature review and found nine randomized controlled trials (n = 964) that compared using either vitamin E, thiazolidinediones (TZDs), pentoxifylline or obeticholic acid (OCA) in 964 patients with NASH. The primary outcome was improvement in fibrosis stage. In addition, the researchers assessed for relative risks and 95% credible intervals from Bayesian network meta-analysis and used Grading of Recommendations Assessment, Development and Evaluation criteria to determine the quality of the evidence. Mean age of the patients in the studies ranged from 45 to 53 years and 30% to 69% were men.

For balloon degeneration, the researchers found that vitamin E (RR = 0.73; 95% CI, 0.61-0.86), TZDs (RR = 0.81; 95% CI, 0.71-0.93) and OCA (RR = 0.75; 95% CI, 0.65-0.96) were associated with improvement compared to placebo. For liver fibrosis, they found that pentoxifylline (RR = 0.8; 95% CI, 0.65-0.98) and OCA (RR = 0.81; 95% CI, 0.7-0.95) showed the most improvement compared to placebo. For steatosis, they found that TZDs (RR = 0.62; 95% CI, 0.46-0.83), pentoxifylline (RR = 0.61; 95% CI, 0.4-0.92) and OCA (RR = 0.66; 95% CI, 0.51-0.85) had more improvement compared to placebo. In addition, for lobular inflammation, TZDs (RR = 0.63; 95% CI, 0.47-0.85), pentoxifylline (RR = 0.71; 95% CI, 0.54-0.94) and OCA (RR = 0.74; 95% CI, 0.59-0.92) showed more improvement than placebo.

 “Using network meta-analysis, we observed that pentoxifylline, TZDs, and vitamin E are superior to placebo and comparable to one another for improving key histological features of NASH,” Singh and colleagues wrote. “OCA also appears promising, though additional data are warranted.” – by Will Offit

Disclosures: The researchers report no relevant financial disclosures.