Efficacy of pioglitazone in treatment of metabolic dysfunction-associated fatty liver disease

Background and aim Nonalcoholic fatty liver disease has emerged as a major public health challenge, with limited approved pharmacological therapies. Pioglitazone has been investigated as a potential treatment for nonalcoholic fatty liver disease, particularly in the context of metabolic dysfunction-associated fatty liver disease (MAFLD). So, this study aimed to evaluate the efficacy of pioglitazone in treating MAFLD by assessing changes in hepatic steatosis, fibrosis, liver enzymes, lipid profiles, and other metabolic parameters. Patients and methods A randomized controlled study was conducted on 100 nondiabetic patients with MAFLD, divided into two groups: group A (n=50) received pioglitazone (30 mg/day) for 24 weeks, and group B (n=50) served as the control group. Clinical, biochemical, and radiological assessments, including transient elastography, were performed at baseline and after 24 weeks. Results The Pioglitazone group showed significant improvements compared with the control group, including reductions in the proportion of severe steatosis (grade S3) from 62 to 12% with pioglitazone. Controlled attenuation parameter scores decreased from 300.5±39.76 to 251.7±35.22 dB/m with pioglitazone. Liver enzymes alanine aminotransferase and aspartate aminotransferase improved significantly. Total cholesterol declined from 220.3±74.34 to 180.5±47.71 mg/dl with pioglitazone. Serum uric acid also decreased, from 5.1±1.08 to 4.7±0.85 pioglitazone. However, no significant differences were observed in hepatic fibrosis grades. Conclusion Pioglitazone demonstrated therapeutic potential in managing MAFLD by alleviating hepatic steatosis and ameliorating metabolic dysregulation. These findings support the use of these intervention as adjunctive therapies for MAFLD, warranting further investigation into their long-term efficacy and impact on hepatic fibrosis.