Efficacy of Metabolic Dysfunction-Associated Steatotic Liver Disease Pharmacotherapies in Non-Alcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis

• • Pioglitazone significantly improved NAFLD activity score (NAS) by a mean difference of -1.2 (95% CI -1.8 to -0.6, p<0.001) and resolved steatohepatitis in 2.1 times more patients (RR 2.1, 95% CI 1.4-3.1), underscoring its histological benefit in clinical practice. • • GLP-1 receptor agonists reduced hepatic fat content by a mean difference of -4.5% (p<0.01) and serum ALT by -15 U/L (p<0.001), indicating robust biochemical and steatotic improvements. • • Novel agents, such as resmetirom, demonstrated a significant reduction in fibrosis stage (MD -0.3, p=0.02), offering a potential anti-fibrotic effect beyond existing therapies. • • Adverse events were predominantly mild gastrointestinal symptoms, with no significant increase in serious adverse events, supporting acceptable tolerability for chronic use.