Comparative Efficacy of SGLT2 Inhibitors in MASLD: Bayesian Network Meta-Analysis of CAP-LSM Outcomes and Time Effects
Abstract
Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disorder worldwide. Sodium-glucose cotransporter-2 (SGLT2) inhibitors, glucose-lowering agents with cardiovascular benefits, have shown hepatoprotective potential. Their comparative effects on steatosis and fibrosis, their interrelationship, and the role of treatment duration remain uncertain.
Objectives: To compare the effects of individual SGLT2 inhibitors on hepatic steatosis and fibrosis, and to assess correlations between controlled attenuation parameter (CAP) and liver stiffness measurement (LSM), as well as the impact of treatment duration.
Methods: Randomized controlled trials of SGLT2 inhibitors in MASLD were synthesized using Bayesian network meta-analysis. Hepatic steatosis (CAP) and fibrosis (LSM) were analyzed separately as mean differences (MDs) with 95% credible intervals (CrIs). Prespecified study-level effect modifiers were evaluated using Bayesian network meta-regression. Comparative rankings were derived using the surface under the cumulative ranking curve (SUCRA). Trial-level concordance between CAP and LSM was assessed using bivariate Bayesian meta-analysis.
Results: Fourteen RCTs (n = 855) were included. Compared with standard care, SGLT2 inhibitors reduced CAP (MD 10.48 dB/m; 95% CrI 0.53 to 18.72) and LSM (MD 0.57 kPa; 95% CrI 0.02 to 1.12). Dapagliflozin showed the most consistently favorable estimates across both outcomes. Trial-level…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 855 participants or records.
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