■NASH的药物治疗与脂质调节有关,但是关于药物治疗的共识有限,缺乏有效性的比较分析。进行了网络荟萃分析,以比较脂质调节中的NASH药物类别。
■在线数据库中搜索了评估经活检证实的NASH患者NASH治疗的随机对照试验(RCT)。治疗分为四组:(1)炎症,(2)能源,(3)胆汁酸,和(4)基于作用机制的纤维化。进行贝叶斯网络分析,其结果通过具有可信间隔(Crl)的平均差(MD)和累积排名曲线(SUCRA)下的表面来测量。
■分析中包括了44个随机对照试验。胆汁酸调节治疗(MD:0.05,Crl:0.03-0.07)是改善高密度脂质(HDL)胆固醇的最佳治疗方法,与安慰剂相比,其次是调节能量(MD:0.03,Crl:0.02-0.04)和纤维化(MD:0.01,Crl:-0.12至0.14)的治疗。减少甘油三酯的前三种治疗是调节能量的治疗(MD:-0.46,Crl:-0.49至-0.43),胆汁酸(MD:-0.22,Crl:-0.35至-0.09),和炎症(MD:-0.08,Crl:-0.13至-0.03)与安慰剂相比。SUCRA发现,与安慰剂相比,调节纤维化的治疗(MD:-1.27,Crl:-1.76至-0.79)是降低低密度脂质(LDL)胆固醇的最佳治疗方法,其次是调节炎症(MD:-1.03,Crl:-1.09至-0.97)和能量(MD:-0.37,Crl:-0.39至-0.34)。但是通过调节胆汁酸的治疗使LDL胆固醇恶化。
■比较NASH中血脂异常调节的类别效应的网络分析发现,治疗目标可以包括优化致动脉粥样硬化的血脂异常。未来的研究需要评估心血管结局。
UNASSIGNED: Pharmaceutical therapy for NASH is associated with lipid modulation, but the consensus on drug treatment is limited and lacks comparative analysis of effectiveness. A network meta-analysis was conducted to compare NASH drug classes in lipid modulation.
UNASSIGNED: Online databases were searched for randomized controlled trails (RCTs) evaluating NASH treatments in biopsy-proven NASH patients. Treatments were classified into four groups: (1) inflammation, (2) energy, (3) bile acids, and (4) fibrosis based on the mechanism of action. A Bayesian network analysis was conducted with outcome measured by mean difference (MD) with credible intervals (Crl) and surface under the cumulative ranking curve (SUCRA).
UNASSIGNED: Forty-four RCTs were included in the analysis. Bile acid modulating treatments (MD: 0.05, Crl: 0.03-0.07) were the best treatment for improvement in high-density lipid (HDL) cholesterol, followed by treatments modulating energy (MD: 0.03, Crl: 0.02-0.04) and fibrosis (MD: 0.01, Crl: -0.12 to 0.14) compared with placebo. The top three treatments for reduction in triglycerides were treatments modulating energy (MD: -0.46, Crl: -0.49 to -0.43), bile acids (MD: -0.22, Crl: -0.35 to -0.09), and inflammation (MD: -0.08, Crl: -0.13 to -0.03) compared with placebo. SUCRA found treatment modulating fibrosis (MD: -1.27, Crl: -1.76 to -0.79) was the best treatment for reduction in low-density lipid (LDL) cholesterol followed by treatment modulating inflammation (MD: -1.03, Crl: -1.09 to -0.97) and energy (MD: -0.37, Crl: -0.39 to -0.34) compared with placebo, but LDL cholesterol was worsened by treatments modulating bile acids.
UNASSIGNED: Network analysis comparing the class effects of dyslipidemia modulation in NASH found that treatment targets can include optimization of atherogenic dyslipidemia. Future studies are required to evaluate the cardiovascular outcomes.