Effects of losartan in patients with NAFLD: A meta-analysis of randomized controlled trial

Abstract

Losartan has become a hot spot in the treatment of non-alcoholic fatty liver disease (NAFLD) among angiotensin receptor blocker drugs. We sought to conduct a systematic examination and meta-analysis to examine the effects of losartan on patients with NAFLD. We searched for potentially randomized controlled trials in PubMed, Embase, China National Knowledge Infrastructure, Wanfang, and the Cochrane database up to October 09, 2022. We used the Cochrane risk of bias tool to evaluate the study quality. Analysis of subgroups, sensitivity analysis, and publishing bias were explored. The quality of the included studies was moderate to high. Six trials involving 408 patients were included. The meta-analysis demonstrated that aspartate transaminase was significantly affected by losartan therapy (mean difference [MD] = −5.34, 95% confidence interval [CI] [−6.54, −4.13], Z = 8.70, P < 0.01). The meta-analysis subgroup showed that losartan 50 mg once daily could lower the level of alanine aminotransferase (MD = −18.92, 95% CI [−21.18, −16.66], Z = 16.41, P < 0.01). There was no statistically significant difference in serum total cholesterol, triglyceride, low-density lipoprotein, and high-density lipoprotein.

The Renin–Angiotensin System in Liver Disease

“…Losartan has been shown to attenuate fibrosis in patients with chronic hepatitis C and alcohol-associated liver disease, as well as to attenuate steatosis in MASH and MASLD, although a comparison to ACEi was absent ( Table 1 ) [ 121 , 122 , 128 , 129 ]. In a small human study, all seven MASH patients had favorable transaminases, plasma TGF-β1, and ferritin levels after losartan administration; histological fibrosis improved in 4/7 patients [ 120 ].…”

Potential Therapeutic Strategies in the Treatment of Metabolic-Associated Fatty Liver Disease

“…The data from selected meta-analyses might suggest that several drugs commonly used in patients with cardiovascular diseases with concomitant MAFLD (e.g., losartan and acetylsalicylic acid) have positive impacts on hepatic enzyme levels or protect against progression to advanced fibrosis [210,211]. Nevertheless, currently, the level of evidence is underwhelming.…”