Study of the efficacy of coadministration of pioglitazone and vitamin E compared to coadministration metformin and ursodeoxycholic acid (UDCA) on ultrasound scoring and liver enzymes in patients with non-alcoholic fatty liver

Abstract

Introduction: Non-alcoholic fatty liver disease is one of the main causes of liver disease worldwide which a treatment for that is still a major challenge. Insulin resistance and oxidative stress play a key role in the pathogenesis of this disease. Purpose: Study of the efficacy of coadministration of pioglitazone and vitamin E compared to coadministration metformin and ursodeoxycholic acid (UDCA) on ultrasound scoring and liver enzymes in patients with non-alcoholic fatty liver Methods: This study is a RCT. 185 patients were randomly selected and divided into two groups of intervention. The study population was aged between 18 and 65 years old with diagnosed non-alcoholic fatty liver and non diabetic. One group of patients receives Pioglitazone 15mg and Vitamin E800IU and the other group receives Metformin 500mg and UDCA 300mg (TID) and is monitored for liver ultrasound and liver enzymes, pregnant and lactating women and alcohol users have been excluded from the study. Results: Changes in the level of liver grade and AST and ALT enzymes were significant between two groups. Intra-group studies showed a significant decrease in fatty liver grade and liver enzymes levels in the pioglitazone and Vit E groups as opposed to the metformin and UDCA groups. There was also a significant difference in the HDL, FBS and BMI parameters in the pioglitazone group. Significant decrease in body weight (P = 0.025) and decrease in total cholesterol (P = 0.05) were also among the therapeutic effects of metformin and UDCA. Conclusion: Concomitant administration of pioglitazone and vitamin E is both more effective in reducing fatty liver ultrasound and improving liver enzymes than concomitant administration of metformin and UDCA.