Bayesian network meta-analysis of drugs for pediatric NAFLD steatosis improvement
This Bayesian network meta-analysis examined pharmacological interventions for pediatric nonalcoholic fatty liver disease (NAFLD). The study included 1,582 patients confirmed by ultrasound or biopsy and categorized drugs into energy, inflammation, fibrosis, and gut microbiota modulators. The primary outcome was improvement in hepatic steatosis, with secondary outcomes including liver enzymes, lipid profiles, and metabolic parameters.
Energy modulators demonstrated greater effectiveness than placebo for improving hepatic steatosis, with a relative risk of 3.32 and a 95% credible interval of 1.52–8.26. Inflammation modulators also showed superiority over placebo with a relative risk of 2.33 and a 95% credible interval of 1.09–5.27. Gut microbiota modulators exhibited the highest relative risk at 4.60 with a 95% credible interval of 1.42–15.69.
For specific metabolic outcomes, energy modulators were identified as optimal agents for reducing serum ALT levels, decreasing triglyceride contents, increasing HDL-C levels, and improving HOMA-IR. The SUCRA scores for these outcomes were 86.20%, 91.77%, 94.29%, and 88.01% respectively. Conversely, gut microbiota modulators were the most effective agents for reducing BMI, achieving a SUCRA score of 96.25%.
The authors note that adverse events, serious adverse events, discontinuations, and tolerability were not reported in the source data. This systematic review serves as a valuable guide for optimizing drug development and selecting agents for combination therapies. Clinicians should interpret these pooled estimates with caution, recognizing that the evidence derives from a Bayesian network meta-analysis rather than a single randomized trial.
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