Network meta-analysis finds pegozafermin, OCA, and resmetirom outperform placebo for MASLD fibrosis improvement

A systematic review and network meta-analysis examined the comparative efficacy of pharmacologic therapies for metabolic dysfunction-associated steatotic liver disease (MASLD) in adult patients. The analysis included 10,119 participants from multiple databases, comparing pegozafermin, obeticholic acid (OCA), resmetirom, and pegbelfermin against placebo, with a primary outcome of more than 1-stage fibrosis improvement and secondary outcomes including changes in liver stiffness measurement via vibration-controlled transient elastography (VCTE) and magnetic resonance elastography.

For fibrosis stage F1-3 analysis, pegozafermin, OCA, and resmetirom all outperformed placebo, though specific effect sizes, absolute numbers, and confidence intervals were not reported. In the 1.5-year analysis, OCA was superior to placebo, and in the 0.5-year analysis for decreasing LSM via VCTE, pegozafermin significantly outperformed placebo. Again, precise numerical data for these comparisons were not provided in the available evidence.

Safety and tolerability data, including adverse events, serious adverse events, and discontinuation rates, were not reported. The key limitation noted is that more definitive efficacy conclusions will depend on the results of phase III clinical trials. Funding sources and conflicts of interest were also not reported.

Given the absence of detailed safety profiles and the reliance on aggregated data without specific effect metrics, clinicians should interpret these findings cautiously. The restrained practice relevance is that this network meta-analysis suggests potential efficacy signals for several agents in MASLD fibrosis improvement, but phase III trial data are needed to confirm these observations and establish safety profiles before clinical application.