Evidence map›Paper›PMID 40487374›Full record

ReviewJGH open : an open access journal of gastroenterology and hepatology2025

Peroxisome Proliferator-Activated Receptor (PPAR) Agonists for Patients With Primary Biliary Cholangitis With Inadequate Response to Ursodeoxycholic Acid (UDCA): A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Maadeha H Zaidi, Zaroon Haider, Fnu Sadia, Muhammad Tayyab, Muhammad Naveed Tariq, Hasaan H Ans, Muhammad Bilal Javaid, Ahmad Khan, Muhammad Hassan Ahmad, Rahman Rasheed and 8 more

Abstract readReview
In one paragraph

Review in JGH open : an open access journal of gastroenterology and hepatology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Review
  2. Article
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

18 authors.

Maadeha H ZaidiDepartment of Medicine Fudan University Shanghai China.
Zaroon HaiderDepartment of Medicine CMH Lahore Medical College Lahore Pakistan.
Fnu SadiaDepartment of Medicine Jinnah Sindh Medical University Karachi Pakistan.
Muhammad TayyabDepartment of Medicine Faisalabad Medical University Faisalabad Pakistan.
Muhammad Naveed TariqDepartment of Medicine Khyber Medical University Peshawar Pakistan.
Hasaan H AnsDepartment of Medicine FMH College of Medicine & Dentistry Lahore Pakistan.
Muhammad Bilal JavaidDepartment of Medicine CMH Lahore Medical College Lahore Pakistan.ORCID https://orcid.org/0009-0002-3060-3833
Ahmad KhanDepartment of Medicine Khyber Medical University Peshawar Pakistan.
Muhammad Hassan AhmadDepartment of Medicine Allama Iqbal Medical College Lahore Pakistan.
Rahman RasheedDepartment of Medicine Bahira University of Health Sciences Karachi Pakistan.
Uzair JafarDepartment of Medicine King Edward Medical University Lahore Pakistan.
Huzaifa Ahmad CheemaDepartment of Medicine King Edward Medical University Lahore Pakistan.
Asma'a Munasar Ali AlsubariFaculty of Medicine Sana'a University Sana'a Yemen.ORCID https://orcid.org/0009-0005-1722-3926
Muhammad ShahzilDepartment of Internal Medicine Milton S Hershey Medical Center, The Pennsylvania State University Hershey Pennsylvania USA.ORCID https://orcid.org/0000-0002-4010-7545
Essam RashadDepartment of Internal Medicine Parkview Regional Medical Center Fort Wayne Indiana USA.
Rehmat Ullah AwanDepartment of Gastroenterology and Hepatology West Virginia University Morgantown West Virginia USA.
Hassam AliDepartment of Gastroenterology, Hepatology & Nutrition ECU Health Medical Center/Brody School of Medicine Greenville North Carolina USA.ORCID https://orcid.org/0000-0001-5546-9197
Prasun K JalalSection of Gastroenterology and Hepatology, Department of Medicine Baylor College of Medicine Houston Texas USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Objective: Peroxisome proliferator-activated receptor (PPAR) agonists are agents used for patients with primary biliary cholangitis (PBC) who do not respond to conventional agents like ursodeoxycholic acid (UDCA). This meta-analysis aimed to assess the safety and efficacy of PPAR agonists, including fibrates and selective PPAR agonists, on biochemical response and safety outcomes in patients with primary biliary cholangitis who were non-responders to UDCA. Methods: We searched various electronic databases, including MEDLINE (via PubMed), Embase, the Cochrane Library, and ClinicalTrials.gov, to retrieve randomized controlled trials (RCTs) comparing PPAR agonists to placebo in patients with PBC. Results: Our meta-analysis, including 12 RCTs involving 973 patients, showed that PPAR agonists, including fibrates and selective PPAR agonists, significantly reduce mean alkaline phosphatase (ALP) levels from baseline to follow-up as compared to placebo. They also increase the number of patients with the composite biochemical response (RR 5.51; 95% CI: 2.80, 10.86) and normalize ALP levels with a reduction in pruritus NRS Score and the incidence of pruritus. There was no significant change between the two groups when assessing the mean change in total bilirubin, adverse events, serious adverse events, or mean change in PBC-40 score. Conclusion: In conclusion, our research underscores the potential of novel PPAR agonists in improving biochemical markers in PBC, particularly in patients unresponsive to UDCA. However, further studies with larger sample sizes, longer follow-up durations, and a focus on patient-centered outcomes are necessary. Additionally, exploring combination therapies and mechanistic insights will help us fully realize the therapeutic potential of PPAR agonists in PBC.

Indexed as

elafibranorfibratesPBCPPAR agonistprimary biliary cholangitissaroglitazarseladelpar

Identifiers

PMID40487374
PMCPMC12141920

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.