Comparative effectiveness of medical treatment *** surgery for histologically proven non-alcoholic steatohepatitis and fibrosis:a matched network meta-analysis

作     者：Adrian T.Billeter Beatrice Reiners Svenja E.Seide Pascal Probst Eva Kalkum Christian Rupp Beat P.Müller-Stich 

作者机构：Department of GeneralVisceral and Transplant SurgeryUniversity of HeidelbergHeidelbergGermany Institute of Medical Biometry and InformaticsUniversity of HeidelbergHeidelbergGermany The Study Center of the German Surgical Society(SDGC)HeidelbergGermany Department of Gastroenterology and HepatologyUniversity of HeidelbergHeidelbergGermany 

出 版 物：《Hepatobiliary Surgery and Nutrition》 (肝胆外科与营养（英文）)

年 卷 期：2022年第11卷第5期

页      面：696-708,I0008-I0011页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：Non-alcoholic fatty liver disease(NAFLD) non-alcoholic steatohepatitis(NASH) metabolic surgery fatty liver 

摘      要：Background:Non-alcoholic steatohepatitis(NASH)comprises a major healthcare problem affecting up to 30%of patients with obesity and the associated risk for cardiovascular and liver-related *** new drugs for NASH-treatment are currently *** study thus far directly compared surgical and non-surgical therapies for *** network meta-analysis compares for the first time the effectiveness of different therapies for NASH using a novel statistical ***:The study was conducted according to the PRISMA guidelines for network ***,CENTRAL and Web of Science were searched without restriction of time or language using a validated search *** investigating therapies for NASH in adults with liver biopsies at baseline and after at least 12 months were *** with liver cirrhosis were *** of bias was assessed with ROB-2 and ROBINS-I-tools.A novel method for population-adjusted indirect comparison to include and compare single-arm trials was *** outcomes were NASH-resolution and improvement of ***:Out of 7,913 studies,twelve randomized non-surgical studies and twelve non-randomized surgical trials were ***-resolution after non-surgical intervention was 29%[95%confidence interval(CI):23-40%]and 79%(95%CI:72-88%)after *** network meta-analysis showed that surgery had a higher chance of NASH-resolution than medication[odds ratio(OR)=2.68;95%CI:1.44-4.97]while drug treatment was superior to placebo(OR=2.24;95%CI:1.55-3.24).Surgery(OR=2.18;95%CI:1.34-3.56)and medication(OR=1.79;95%CI:1.39-2.31)were equally effective to treat fibrosis compared to placebo without difference between *** results did not change when only new drugs specifically developed for the treatment of NASH were ***:Metabolic surgery has a higher effectiveness for NASH-therapy than medical therapy while both were equally effective regarding improvement of *** d