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Efficacy of Telmisartan in MASLD/NAFLD: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Shayan Shojaei1,2, Dorsa Shekouh3, Asma Mousavi1,2
1Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Background:
Activation of the renin-angiotensin-aldosterone system contributes to hepatic inflammation in metabolic dysfunction-associated steatotic liver disease (MASLD). Telmisartan, an angiotensin II receptor blocker with partial PPAR-γ agonistic activity, has been hypothesized to confer metabolic benefits; however, current clinical evidence has not consistently demonstrated such effects.
Aim:
This systematic review and meta-analysis evaluated the efficacy of telmisartan on metabolic, biochemical, and histological outcomes in MASLD.
Methods:
Electronic databases (PubMed, Embase, Web of Science, Scopus) were searched through 2026 for randomized controlled trials (RCTs) investigating telmisartan in adults with MASLD. Risk of bias was assessed using the RoB2 tool. Random-effects meta-analyses calculated pooled mean differences (MDs) with 95% confidence intervals (CIs).
Results:
Six RCTs comprising 258 participants (126 telmisartan, 132 controls) met the inclusion criteria. Telmisartan treatment was associated with a modest reduction in fasting blood sugar compared with controls (MD = -2.78 mg/dL; 95% CI -5.17 to -0.39; p = 0.023); however, this finding was accompanied by substantial heterogeneity (I2 = 91.8%) and should therefore be interpreted cautiously. No significant changes were observed for body mass index, waist circumference, HOMA-IR, lipid profiles, ALT, or AST. Conversely, gamma-glutamyl transferase (GGT) levels showed a modest but significant increase with telmisartan (MD = 5.40 U/L; 95% CI 0.51 to 10.29; p = 0.031). Histological analyses revealed a non-significant trend toward fibrosis stage improvement (MD = -0.28; 95% CI -0.57 to 0.01; p = 0.060), with no significant improvements seen in the overall NAFLD activity score, steatosis, ballooning, or lobular inflammation. Most included trials carried a low overall risk of bias.
Conclusion:
Current evidence does not demonstrate consistent metabolic, biochemical, or histological benefits of telmisartan in MASLD. Although a modest reduction in fasting blood glucose was observed, substantial between-study heterogeneity and the modest effect size limit confidence in this finding.
