Table 1 Major clinical trials assessing thiazolidinediones in patients with MASLD

PPARγ activators

Pioglitazone

247 adults with NASH but without T2DM

Improve liver histology in 34% participants after 96 weeks. Reduce hepatic steatosis and lobular inflammation but not fibrosis

[54]

55 patients with NASH comfirmed by liver biopsy and impaired glucose tolerance or T2DM

Decrease aspartate aminotransferase (AST) by 40%, alanine aminotransferase (ALT) by 58%, liver fat content (LFC) by 54%, increase hepatic insulin sensitivity by 48%. Improve histological steatosis, ballooning necrosis, inflammation but not fibrosis after 6 months

[55]

Rosiglitazone

32 patients with histologically proven NASH

Improve liver steatosis in 47% and serum transaminase levels in 38% of participants after 1 year

[56]

MSDC-0602 K

392 patients with NASH and fibrosis (F1-F3) confirmed by liver biopsy

Improve the result of liver biopsy in 29.8–39.5%. Significantly reduce liver enzymes and NAS scores after 52 weeks

[58]