A Comparison of the Therapeutic Effects of Metformin, Pioglitazone and Vitamin E in Patients with Non-Alcoholic Fatty Liver

Abstract

BACKGROUND AND OBJECTIVE: Non-alcoholic Fatty Liver Disease (NAFLD) is specified by changes in fat in the liver, with or without inflammation. The disease is the hepatic manifestation of metabolic syndrome. Since a different medicinal treatment has been introduced, this study was conducted to compare the therapeutic effects of metformin, pioglitazone and vitamin E in treatment of these patients. METHODS: In this single-blind randomized clinical trial, 93 patients with the diagnosis of NAFLD who referred to Imam Reza Hospital in Kermanshah were randomly divided into three groups (n = 31). Then, the first group received two gr/day metformin, the second group received 30 mg/day pioglitazone and the third group received 800 IU/day vitamin E for 12 weeks. LFTs, BMI, HOMA-IR, FBS, and serum insulin levels were measured before and after the treatment course (IRCT: 2016010411991N3). FINDINGS: There was no significant difference between the groups in terms of distribution of sex, mean age, LFT and HOMA-IR before treatment. The mean difference in severity of NAFLD before or after the treatment was metformin (1.06 ± 0.63), pioglitazone (1.195±0.75) and vitamin E (0.77±0.62), which was statistically significant (p<0.05). In addition, serum insulin levels (p<0.01) and HOMA-IR (p<0.05) were significant between the groups; pioglitazone showed highest effect on reducing the severity of NAFLD, serum insulin levels, and HOMA-IR. Metformin and vitamin E were next in line, respectively. CONCLUSION: Based on the results of this study, pioglitazone is more effective than metformin and vitamin E both in reducing the severity of NAFLD and in lowering LFT and serum insulin levels.

Keywords

• Non-Alcoholic Fatty Liver Disease
• Metabolic Syndrome
• Metformin
• Pioglitazone
• Vitamin E