Key result
Pioglitazone, a PPARγ agonist, increased the number of patients with liver histology alleviation by 41% and NASH resolution by 32% compared to placebo in patients with biopsy-proven NASH.
Why the study?
NAFLD has become a major public health concern, and PPAR agonists play crucial roles in metabolism, inflammation, and fibrosis.
Do PPAR agonists improve liver histology and metabolic parameters in patients with NAFLD/NASH?
Do PPAR agonists improve liver histology and metabolic parameters in patients with NAFLD/NASH?
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Pioglitazone remains a recommended therapy for NASH due to its histological benefits, while novel dual PPAR agonists show potential for balancing metabolic and hepatic improvements without classical PPARγ-mediated side effects.
Nonalcoholic fatty liver disease (NAFLD) has become a major public health concern. Peroxisome proliferator-activated receptors (PPARs) are nuclear receptor transcription factors. PPARs are categorized into three subtypes: PPARα, β/δ, and γ. Three subtypes of PPARs play crucial roles in lipid and glucose metabolism, inflammation and fibrosis. This review summarizes randomized controlled trials on the use of PPAR agonists in the treatment of NAFLD. PPARα and PPARβ/δ agonists control circulatory lipids well, but they do not yield enough liver benefits. PPARγ agonists, particularly pioglitazone, are recommended for NAFLD treatment. PPARα/γ agonists and PPARα/β/γ agonists are plausible in the treatment of NAFLD. More clinical studies are still in need to properly unveil the efficacy of PPAR agonists in the treatment of NAFLD.
Li et al. (2026) conducted a review in Nonalcoholic fatty liver disease (NAFLD). PPAR agonists vs. Placebo was evaluated. Pioglitazone, a PPARγ agonist, increased the number of patients with liver histology alleviation by 41% and NASH resolution by 32% compared to placebo in patients with biopsy-proven NASH.
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