Comparative Efficacy of Saroglitazar and Pioglitazone in Nonalcoholic Fatty Liver Disease Patients: A Bayesian Network Meta-analysis

Abstract

Abstract Background and Aims: Nonalcoholic fatty liver disease (NAFLD) is associated with metabolic syndrome. Two drugs, saroglitazar (S) and pioglitazone (P), are known to have beneficial effects on metabolic syndrome. This Bayesian network meta-analysis (NMA) was conducted to compare the relative efficacy of these two drugs in NAFLD patients. Materials and Methods: An electronic search of the Cochrane Library database yielded 12 randomized prospective studies for this NMA. R version 4.2.3 (64-bit) and Comprehensive Meta-Analysis Version 4 were used to analyze the data. Selection bias was screened with a funnel plot, and publication bias was assessed using the Cochrane risk of bias tool. The standardized mean difference (SMD) was used as an effect size estimate, and the surface under the cumulative ranking curve (SUCRA) value was used to rank S and P in comparison to placebo. Results: This NMA was conducted on a pooled population of 930 patients (379 receiving P, 159 receiving S, and 392 receiving placebo) diagnosed with NAFLD either by liver biopsy or radiologically along with transaminase estimation. S (alanine transaminase [ALT] [SMD −4.28, 95% confidence interval (CI) −7.46–−1.02], aspartate transaminase [AST] [SMD − 2.28, 95% CI −3.93–−0.62], and GGT [SMD −4.37, 95% CI − 7.43–−1.30]) and P (ALT [SMD −0.50 95% CI − 0.66–−0.34], AST [SMD − 0.42 95% CI − 0.59–−0.25], and GGT [SMD −1.42, 95% CI − 2.44–−0.41]) showed comparable improvement in inflammatory markers and the SUCRA score between the S and P groups, respectively. There was an impressive improvement in the NAS score by a ≥ 2-point reduction in both the saroglitazar (SMD −0.59, 95% CI − 0.98–−0.20) and the pioglitazone groups (SMD −0.49, 95% CI − 0.83–−0.15), and the SUCRA scores were comparable (0.80 for the S group versus 0.67 for the P group). P and S could not be compared with SUCRA values in view of significant heterogeneity differences concerning steatosis and lobular inflammation. S (SMD −0.77 95% CI − 1.16–−0.38) and P (SMD − 0.54, 95% CI −0.78–−0.30) were comparable in the improvement of hepatic ballooning (0.89 for the S group versus 0.60 for the P group). Conclusion: The efficacy of saroglitazar in improving hepatic markers and prominent biopsy parameters in NAFLD patients is comparable to that of pioglitazone.