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Korean J Intern Med. 2019 Mar;34(2):296-304. doi: 10.3904/kjim.2017.194. Epub 2018 Mar 20.

Ezetimibe decreased nonalcoholic fatty liver disease activity score but not hepatic steatosis.

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Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea.
Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA.



A number of clinical trials reported varying effects of cholesterol lowering agents in nonalcoholic fatty liver disease (NAFLD) patients. We, therefore, assessed the changes in hepatic steatosis and NAFLD activity score (NAS) after treatment with cholesterol lowering agents in NAFLD patients by metaanalysis.


The Cochrane Library, the MEDLINE, and the Embase databases were searched until May 2015, without any language restrictions, for randomized controlled trials (RCTs) and nonrandomized studies (NRSs). Additional references were obtained from review of bibliography of relevant articles. The quality of evidence was assessed using the grading of recommendations assessment, development and evaluation guidelines.


Three RCTs (n = 98) and two NRSs (n = 101) met our study inclusion criteria (adult, NAFLD, liver biopsy). Liver biopsy was performed in all five studies, but only the three studies reported NAS. Ezetimibe significantly decreased NAS (standardized mean difference [SMD], -0.30; 95% confidence interval [CI], -0.57 to -0.03) but not hepatic steatosis in RCT (SMD, -0.1; 95% CI, -0.53 to 0.32), while the effect was significant for both NAS and intrahepatic content in NRSs (SMD, -3.0; 95% CI, -6.9 to 0.91).


Ezetimibe decreased NAS without improving hepatic steatosis.


Ezetimibe; Hydroxymethylglutaryl-CoA reductase inhibitors; Meta-analysis; Non-alcoholic fatty liver disease

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