Efficacy of Pharmacotherapies in Improving Liver Fibrosis among Patients with Metabolic Associated Steatotic Liver Disease and F1-F3 Fibrosis: Network Meta-Analysis

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common cause of chronic liver disease, and its incidence has risen markedly worldwide. It is an umbrella term for a range of liver conditions, including non-alcoholic fatty liver (NAFL), non-alcoholic steatohepatitis (NASH), simple fatty liver (SFL), cirrhosis, and hepatocellular carcinoma (HCC). As research into its mechanisms continues to advance, MASLD—previously referred to as non-alcoholic fatty liver disease (NAFLD)—and NASH have been redefined, with the latter now termed metabolic dysfunction-associated steatohepatitis (MASH). According to the guidelines of the American Association for the Study of Liver Diseases (AASLD), non-alcoholic steatohepatitis (NASH) involves not only fat accumulation but also lobular inflammation, hepatocellular ballooning degeneration, and fibrosis. The fibrosis it causes increases the risk of complications such as cirrhosis and liver-related mortality. The article not only discusses resmetirom (a drug approved for the treatment of MASH) but also describes the application and prospects of other novel drugs for MASH treatment. However, evidence remains insufficient for comparing the efficacy of different pharmacological treatments in MASH patients with stage F1–F3 fibrosis. In recent years, research findings on the effectiveness of drugs for MASH have shown significant inconsistencies. Furthermore, no meta-analysis has compared the efficacy of various drugs in treating hepatitis patients with F1–F3 fibrosis, nor has there been a systematic review to synthesize these data. By integrating direct and indirect evidence from a network of randomized controlled trials (RCTs), this network meta-analysis enables the simultaneous comparison of multiple intervention strategies. The primary objective of this article is to evaluate the efficacy and safety of different drugs in treating patients with metabolic dysfunction-associated steatohepatitis (MASH) and F1–F2 fibrosis, thereby providing evidence-based guidance for clinical practice.