Effects of chiglitazar on glycemic, lipid, and hepatic outcomes: A systematic review and meta-analysis

Chiglitazar is a peroxisome proliferator-activated receptor pan-agonist with potential metabolic benefits. This systematic review and meta-analysis assessed its efficacy and safety versus placebo or active comparators in adults with metabolic disorders.

PubMed, Scopus, and Web of Science were searched up to August 2026 for studies assessing chiglitazar in adults with metabolic disorders. Outcomes were pooled via random-effects meta-analysis with 95% confidence intervals, alongside heterogeneity, subgroup, and sensitivity analyses.

Five studies involving 1,457 participants were included. Chiglitazar reduced fasting glucose at 24 weeks (MD - 0.99 mmol/L, 95% CI - 1.75 to - 0.24). HbA1c decreased at 12 weeks (MD - 0.52% points, 95% CI - 0.68 to - 0.37), but its 24-week reduction was not statistically significant. Fasting insulin decreased at 12 weeks (SMD - 0.25, 95% CI - 0.39 to - 0.11), and HOMA-IR decreased at 12 and 24 weeks. Triglyceride levels decreased and HDL-C increased at both time points; total and LDL cholesterol increased at 12 weeks. At 12 weeks, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) decreased (MD - 4.44 U/L, 95% CI - 6.09 to - 2.79; and - 1.23 U/L, 95% CI - 2.28 to - 0.19, respectively). AST decreased at 24 weeks (MD - 3.03 U/L, 95% CI - 5.85 to - 0.21), whereas ALT did not significantly decrease (MD - 4.52 U/L, 95% CI - 9.34 to 0.30). No significant differences in overall or serious adverse events were detected; edema was increased (RR 8.77, 95% CI 1.60-47.97).

Chiglitazar may improve short-term glycemic control, insulin sensitivity, selected lipid measures, and aminotransferase levels in adults with metabolic disorders. Increased edema risk, heterogeneity, and limited follow-up warrant cautious interpretation; long-term clinical benefits remain unproven.

The online version contains supplementary material available at https://doi.org/10.1007/s40200-026-02119-8.