A Comparison of the Therapeutic Effects of Pioglitazone and Metformin in Non-alcoholic Steatohepatitis

Non-alcoholic steatohepatitis (NASH) is a common liver disease that, in the absence of treatment may progress to cirrhosis. There is a strong association of NASH with insulin resistance; thus insulin sensitizer drugs have been used for this disease. The aim of this study was to compare the effect of pioglitazone with metformin on liver transaminases, the HOMA Index, and adiponectin in patients with NASH. Mterials and This double-blind clinical trial was performed on 80 patients diagnosed with NASH according to imaging and abnormal liver function tests. Patients were divided into two groups (n=40) based on block randomization. In one group patients received metformin (500 mg, bid) and the other group received pioglitazone (30 mg, qd) for 4 months. AST, ALT, alkaline phosphatase, FBS, and lipid profiles were evaluated before the study and at two and four months after. HOMA Index and adiponectin levels were evaluated before the study and at four months later. Data analysis was carried out with SPSS using repeat measurement and ANCOVA tests. p‹0.05 was considered significant. We included a total of 40 patients (37 males) in the pioglitazone group and 40 patients (31 males) in the metformin group in this study. There was no significant difference in both groupsin terms of age, sex, and weight. ALT and alkaline phosphatase levels decreased significantly in the pioglitazone group compared with the metformin group. There was no significant difference in both groups in AST, FBS, TG, LDL, HDL, and HOMA Index levels. After treatment, the adiponectin level in the metformin group was less than the pioglitazone group. The results showed that pioglitazone was more effective than metformin and led to a greater reduction in the level of liver transaminases. Pioglitazone and metformin had the same effect on FBS and HOMA Index. Both drugs reduced adiponectin levels, but this effect in pioglitazone group was less than the metformin group.