Comparison of the Effects of Metformin and Pioglitazone on Liver Enzymes and Ultrasound Changes in Non-Diabetic Non-Alcoholic Fatty Liver

Study Overview
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Brief Summary
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BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is a spectrum of hepatic disease ranging from fat accumulation in liver to fibrosis and cirrhosis. It affects 25% of the world population on average. Objective of this study is to compare the effect of metformin (1000 milligrams daily) versus pioglitazone (30 milligrams daily) in improving liver transaminases and ultrasound changes in non-diabetic patients of NAFLD when given for six months. METHODS: A Quasi-experimental study was conducted in Mayo Hospital Lahore from October 2019 to November 2020.Out of 96 half Patients were assigned randomly to Group-A (metformin) or Group-B (pioglitazone). Demographic history, abdominal ultrasound & liver enzymes were recorded on Proforma monthly till 6 months. Data was put into and analyzed by SPSS version 26; t-test was used to compare the mean liver transaminases between the two groups. Ultrasound findings were compared by Chi square. The P value of less than 0.05 was counted as significant.

Official Title
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Comparison of the Effects of Metformin and Pioglitazone on Liver Enzymes

Conditions
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NAFLD

Intervention / Treatment
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* Drug: Metformin and Pioglitazone


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Gender: Both male and female Age: 18-80 Years Ultrasound evidence of fatty liver as per operational definition Liver enzymes as per operational definition Exclusion Criteria: Pregnancy Cirrhotic patients as per operational definition Chronic Hepatitis B or chronic hepatitis C Patients taking long term steroids, highly active antiretroviral therapy, diltiazem, irinotecan, oxaliplatin and amiodarone Patients taking alcohol (based on history and AST to ALT ratio) Patients with heart failure (NYHA Classification class III or IV status: patients comfortable at rest but less than ordinary physical activity causes undue fatigue, dyspnea or palpitations) Patients with renal failure (serum creatinine ≥ 1.4 mg% or eGFR < 45 ml/min/1.73 m2)

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Metformin Group<br>Group-A; every participant took 500 mg of metformin daily | Drug: Metformin and Pioglitazone<br>* Every participant in Group-A took tablet metformin 500 mg daily and every participant in Group-B took tablet pioglitazone 30 mg daily.<br>|
| Active Comparator: Pioglitazone Group<br>Group-B; every participant took 30 mg of pioglitazone daily | Drug: Metformin and Pioglitazone<br>* Every participant in Group-A took tablet metformin 500 mg daily and every participant in Group-B took tablet pioglitazone 30 mg daily.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Liver transaminase levels | There should be a 22% or more change in transaminases levels from baseline. | The comparison is done after 6 months of drug treatment | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Fatty Liver Grade | There should be a change of liver fat content determined by ultrasound as Fatty Liver Grade | The comparison is done after 6 months of drug treatment |