■非酒精性脂肪性肝炎(NASH)是一种严重的医学疾病,几乎没有可用的治疗选择。Resmetrom,甲状腺激素受体(THR)的肝脏靶向激动剂,最近获得了FDA的许可。我们评估瑞美替罗对NASH患者的有效性和安全性。
■PubMed,搜索SCOPUS和CochraneCentral直到2024年3月才能找到潜在的文章。评估的结果包括MRI-质子密度脂肪分数(MRI-PDFF),脂肪减少,和NASH分辨率无纤维化,天冬氨酸氨基转移酶(AST)的变化,丙氨酸氨基转移酶(ALT),γ-谷氨酰转肽酶(GGT),低密度脂蛋白(LDL),和甘油三酯(TG)水平,伴随着腹泻,恶心,尿路感染(UTI),和头痛。在6个月之前和之后的结果之间进行亚组分析。结果用随机效应模型分析,结果以连续结果的平均差(MD)和安全性分析的优势比(OR)表示。以及他们95%的置信区间。使用Cochrane偏差风险工具进行偏差风险评估。
■我们的分析包括四项随机对照试验(RCT)。Resmetrom显示MRI-PDFF的显著改善,MD为-19.23(P<0.00001)。此外,它导致脂肪减少30%(OR:3.54,P=0.004)和NASH消退,无纤维化(OR:2.41,P=0.04).AST水平没有显著增强,平均差为-0.87,P值为0.73。使用restmetirom导致ALT水平显着改善(MD:-4.36,P值:0.32),GGT水平(MD:-17.87,P值:<0.00001),TG水平(MD:-23.48,P值:<0.00001),LDL水平(平均差:-12.80,P值:<0.00001),和rT3水平(MD:-2.08,P值:<0.00001)。使用Resmetirom与腹泻(OR:2.07,P<0.0001)和恶心(OR:1.81,P=0.0003)的可能性更高。然而,UTI(OR:1.04,P=0.85)或头痛(OR:0.79,P=0.48)的发生率无显著差异。
■Resmetirom证明了增强MRI-PDFF评分的功效,减少脂肪组织,解决NASH无纤维化,减少GGT,TG,LDL,NASH患者的三碘甲状腺原氨酸(rT3)水平逆转。然而,还观察到更容易出现腹泻和恶心。需要进行其他试验以进一步检查该药物的有效性和安全性。
UNASSIGNED: Non-alcoholic steatohepatitis (
NASH) is a severe medical illness that has few available therapeutic options. Resmetirom, a liver-targeting agonist of the thyroid hormone receptor (THR), has recently been licenced by the FDA. We assess the effectiveness and safety of resmetirom in patients with
NASH.
UNASSIGNED: PubMed, SCOPUS and Cochrane Central were searched till March 2024 to find potential articles. Outcomes assessed included MRI-proton density fat fraction (MRI-PDFF), Fat Reduction, and
NASH Resolution Without Fibrosis, changes in aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transpeptidase (GGT), low-density lipoprotein (LDL), and triglyceride (TG) levels, along with diarrhoea, nausea, urinary tract infection (UTI), and headache. Subgroup analysis was performed between outcomes before and after 6 months. Outcomes were analyzed with a random-effects model and results presented as mean difference (MD) for continuous outcomes and odds ratios (OR) for safety analysis, along with their 95% confidence intervals. A risk of bias assessment was performed using Cochrane Risk of Bias tool.
UNASSIGNED: Four randomized controlled trials (RCTs) were included in our analysis. Resmetirom shown a substantial improvement in MRI-PDFF with a MD of -19.23 (P<0.00001). Additionally, it resulted in a 30% reduction in fat (OR: 3.54, P=0.004) and resolution of
NASH without fibrosis (OR: 2.41, P=0.04). There was no notable enhancement observed in AST levels, with a mean difference of -0.87 and a P value of 0.73. The usage of resmetirom resulted in significant improvement in ALT levels (MD: -4.36, P value: 0.32), GGT levels (MD: -17.87, P value: <0.00001), TG levels (MD: -23.48, P value: <0.00001), LDL levels (mean difference: -12.80, P value: <0.00001), and rT3 levels (MD: -2.08, P value: <0.00001). The use of Resmetirom was associated with a higher likelihood of experiencing diarrhoea (OR: 2.07, P<0.0001) and nausea (OR: 1.81, P=0.0003). However, there was no significant difference observed in the occurrence of UTI (OR: 1.04, P=0.85) or headaches (OR: 0.79, P=0.48).
UNASSIGNED: Resmetirom demonstrates efficacy in enhancing MRI-PDFF score, diminishing adipose tissue, resolving NASH without fibrosis, reducing GGT, TG, LDL, reverse triiodothyronine (rT3) levels in
NASH patients. Nevertheless, there is also an observed heightened susceptibility to experiencing diarrhoea and nausea. Additional trials are necessary to further examine the efficacy and safety of this medication.