(P17-010-25) Polypharmacy Prevalence and Side Effects in Metabolic Dysfunction–Associated Steatotic Liver Disease: A Systematic Review and Meta-Analysis

Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a prevalent chronic condition often accompanied by multiple comorbidities requiring complex pharmacological management. This review aims to evaluate the prevalence of polypharmacy, associated side effects, and its effect on quality of life and clinical outcomes in individuals diagnosed with MASLD.

Methods: We conducted a systematic review using MEDLINE, CINAHL, Embase, Cochrane CENTRAL, and Scopus databases, supplemented by a grey literature search, from inception to August 2024. Inclusion criteria were randomised controlled trials, cohort studies, or case-control studies that evaluated the prevalence of polypharmacy and its consequences in adults with MASLD. Three reviewers independently performed study selection and data extraction. The quality of included studies was assessed using the Newcastle-Ottawa Scale. The primary outcome was the prevalence of polypharmacy, with secondary outcomes including side effects and quality of life. A meta-analysis with a random-effect model was performed. 

Results: Six studies were included, of which 5 (totalling 153,855 participants) were used in a meta-analysis. Polypharmacy prevalence ranged from 25% to 89%, with a pooled prevalence of 65% (95% CI: 26, 91), I2=99.6%. Adverse outcomes associated with polypharmacy included increased risk of hepatic encephalopathy-related hospitalisations, reduced quality of life across physical and mental health domains, and augmented liver disease progression, particularly in individuals with advanced MASLD. Commonly used medications, such as anticholinergics and insulin, were linked to significant symptom burdens and metabolic dysregulation. Risk of bias assessments revealed that 50% of included studies had high risk due to limitations in study design, such as cross-sectional design and inconsistent definitions of polypharmacy, which reduced the certainty of evidence.

Conclusions: Polypharmacy is highly prevalent in MASLD and associated with poorer clinical outcomes and reduced quality of life. Interventions such as deprescribing programs and enhanced medication management strategies are needed to mitigate risks and optimize patient care.

Funding Sources: This review was funded by Randox Health. We would like to acknowledge the scientific contributions of Mark Ruddock, Mary Jo Kurth, and Peter Fitzgerald.