A Cochrane review [Abstract] 1 [withdrawn from publication] included 3 studies with a total of 166 subjects. In two trials, metformin was associated with significantly higher normalization of serum alanine aminotransferase (OR 2.83, 95% CI 1.27 to 6.31 versus diet and OR 7.75, 95% CI 2.37 to 25.35 versus vitamin E) and improvement of liver echographic response (OR 5.25, 95% CI 1.09 to 25.21). An improvement of fatty infiltration was observed in a limited number of patients undergoing liver biopsy. In the single pioglitazone trial, a statistically significant improvement of NASH histology was demonstrated.
Comment: The quality of evidence is downgraded by poor methodology of the studies and sparse data.
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