Efficacy of ursodeoxycholic acid in metabolic dysfunction-associated steatotic liver disease: an umbrella review of meta-analyses on liver enzymes.

Abstract

<h4>Objective</h4>This umbrella review aimed to systematically synthesize and evaluate evidence from published meta-analyses regarding the efficacy of ursodeoxycholic acid in metabolic dysfunction-associated steatotic liver disease, focusing on its impact on liver-specific biochemical markers.<h4>Methods</h4>Following Joanna Briggs Institute methodology and registered in PROSPERO (ID: CRD420251250211), a comprehensive search of MEDLINE, EMBASE, Cochrane Library, and Scopus (1985-2025) identified systematic reviews and meta-analyses evaluating UDCA therapy in MASLD. Methodological quality was appraised using AMSTAR-2, ROBIS, and GRADE frameworks. Data on hepatic biomarkers were extracted and synthesized using fixed- or random-effects models depending on heterogeneity (I² statistic). Overlap among primary studies was assessed using the GROOVE tool, and meta-regression explored the influence of treatment duration on ALT dynamics.<h4>Results</h4>Five meta-analyses (33 primary studies; 5,015 participants) were eligible. UDCA demonstrated consistent and statistically significant improvements in key markers of hepatocellular injury, including ALT (SMD = -0.36; 95% CI: -0.69 to -0.03) and AST (SMD = -0.16; 95% CI: -0.22 to -0.10), as well as cholestatic markers such as GGT (SMD = -0.40; 95% CI: -0.63 to -0.18) and ALP (SMD = -0.23; 95% CI: -0.31 to -0.14), total bilirubin decreased modestly (SMD = -0.08; 95% CI: -0.15 to -0.01), while albumin level remained unchanged. Meta-regression showed that longer treatment duration was significantly associated with greater ALT reduction (-0.04 SMD per 6 months; <i>p</i> = 0.034).<h4>Conclusion</h4>UDCA demonstrates consistent hepatoprotective and cholestasis-modifying effects in MASLD. Longer treatment duration may enhance biochemical responses.<h4>Systematic review registration</h4>CRD420251250211.