ArticleSaudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association2024
The combined pioglitazone and topiramate therapy for management of pediatric patients with severe MASLD.
Article in Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.
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4 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Effect of weight loss interventions on liver-related health in children and adolescents with obesity: a systematic review and meta-analyses.International journal of obesity (2005) · 2026Pooled it
- Transcriptomic and Zonal Signatures of Mitochondrial Peroxisomal Dysfunction in HCV Associates with Circulating Mitochondrial DNA Biomarkers.Current issues in molecular biology · 2026Article
- Gaps and challenges in the management of pediatric steatotic liver diseases: a narrative review.World journal of pediatrics : WJP · 2025Review
- Growth Hormone Treatment Normalized Liver Enzymes in an Adolescent with Obesity and Short Statute.Annals of pediatrics · 2024Article
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Abstract
backgroundMetabolic dysfunction associated steatotic liver disease (MASLD) is the most common cause of chronic hepatitis in adult and pediatric patients. Adolescents with severe MASLD can demonstrate a more aggressive disease phenotype as they more commonly develop liver fibrosis than BMI matched adults. Therefore, MASLD is the fastest growing indication for liver transplants in young adults.
methodsPioglitazone has been shown to improve liver histology in adult patients with MASLD, and in some studies, it attenuated liver fibrosis. Despite its perceived efficacy, pioglitazone is not widely used, likely due to its side effect profile, specifically increased weight gain. Topiramate lowers body weight in adolescents and in combination with phentermine, is one of the few FDA-approved medications for the management of obesity in children over 12 years of age. We performed a retrospective review of the outcomes in pediatric patients with severe MASLD, treated with the combined pioglitazone and topiramate therapy.
resultsHere, we report a case series of seven adolescents with severe MASLD and ≥F2 liver fibrosis treated with the combined pioglitazone and topiramate therapy. The combined therapy improved mean serum ALT from 165 ± 80 U/L to 89 ± 62 U/L after 12 months mean duration of treatment. One patient who completed 24 months of the combined therapy demonstrated a decrease in liver stiffness from 8.9 kPa to 5.6 kPa, as assessed by FibroScan elastography. There was a significant increase in body weight during this time, however, body mass index as a percentage of the 95 th percentile adjusted for age and gender did not increase significantly, 151 ± 29% vs. 152 ± 28%. Moreover, waist circumference, mid-upper arm circumference, percent body fat, and muscle mass were not significantly different before and after treatment. Serum lipid levels and hemoglobin A1c also did not change with the treatment.
conclusionIn summary, this case series provides encouraging results about the efficacy of the combined pioglitazone and topiramate therapy for the management of adolescents with severe MASLD, which should be further explored in clinical studies.
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