Abstract
Introduction: The efficacy and safety of fibroblast growth
factor 21 (FGF21) analogs in patients with nonalcoholic steatohepatitis
(NASH) remains unclear. Therefore, we aimed to compare the use of FGF21
analogs with placebo in patients with NASH.
Methods: We searched Medline, Embase, and Cochrane databases
from inception to December 2023. The primary outcomes were:
triglycerides levels, high-density lipoprotein (HDL) levels, low-density
lipoprotein (LDL) levels, NASH resolution, N-terminal type III collagen
propeptide (PRO-C3) levels, and adverse events. Subgroup analyses were
performed according to drug dosages. We used Review Manager 5.4 to pool
the data, assessing heterogeneity with I2.
Results: Eight studies reporting data of 967 patients were
included in this review. Follow-up ranged from 16 to 121 weeks and
dosage ranged from 3 to 70mg a day. When compared to placebo, FGF21
analogs were significantly associated with a reduction in triglycerides
(MD -22.07; 95% CI -36.67 to -7.47) and PRO-C3 (MD -6.12; 95% CI -8.05
to -4.20). There were no significant differences in the resolution of
NASH (RR 3.57; 95% CI 0.91 to 13.94). Higher rates of adverse events
(RR 1.08; 95% CI 1.01 to 1.14) were observed in patients who received
the intervention.
Conclusion: Despite a higher incidence of adverse events for
FGF21 analogs, they showed positive effects on the lipid profile and
biomarker for the formation of fibrotic tissue. However, no improvement
in NASH resolution was observed.
Keywords : FGF21 analog; pegozafermin; efruxifermin;
pegbelfermin; fibrosis; NASH.