On 2017 Aug 09, Norberto Chavez-Tapia commented:

Since the first descriptions about pioglitazone treatment in NAFLD we were skeptical, unfortunately at the present time we still lack pharmacological treatment options for this prevalent disease. Despite the favorable results of this manuscript still does not adequately guide clinicians in decision making; based on this we decide to perform trial sequential analysis for assessment of data reliabity in the cumulative meta-analysis; for improvement in advanced cirrhosis for all NASH patients the analysis shows the robustness, reaching the sample size to cross the monitoring boundaries, indicating that the available data is more than enough to sustain the conclusion. This statistical robustness is companied with a number needed to treat for improvement in advanced cirrhosis for all NASH patients of 14 (95% CI 8.9-29.7), and 11 (95% CI 7.2-22) for rosiglitazone-pioglitazone, and pioglitazone respectively. The best candidate for this therapy are those with advanced fibrosis, for this case the number needed to treat is 3 (95%CI 1.8-4.1), and 2 (95%CI 1.4-2.9) for rosiglitazone-pioglitazone, and pioglitazone respectively. The clinical decision should be balanced with the risks described earlier with pioglitazone use, being one of the most relevant the increased risk of bladder cancer (HR of 2.642; 95%CI: 1,106, 6.31, p=0.029) with a number needed to harm of 1200. This data emphasizes the need of suitable assessment of fibrosis, to promote pioglitazone in highly selected patients, which will offer better benefits, reducing exposure to potential adverse effects. Finally, the references in the figures are incorrect, being difficult to follow the original sources.

On 2017 Aug 09, Norberto Chavez-Tapia commented:

Since the first descriptions about pioglitazone treatment in NAFLD we were skeptical, unfortunately at the present time we still lack pharmacological treatment options for this prevalent disease. Despite the favorable results of this manuscript still does not adequately guide clinicians in decision making; based on this we decide to perform trial sequential analysis for assessment of data reliabity in the cumulative meta-analysis; for improvement in advanced cirrhosis for all NASH patients the analysis shows the robustness, reaching the sample size to cross the monitoring boundaries, indicating that the available data is more than enough to sustain the conclusion. This statistical robustness is companied with a number needed to treat for improvement in advanced cirrhosis for all NASH patients of 14 (95% CI 8.9-29.7), and 11 (95% CI 7.2-22) for rosiglitazone-pioglitazone, and pioglitazone respectively. The best candidate for this therapy are those with advanced fibrosis, for this case the number needed to treat is 3 (95%CI 1.8-4.1), and 2 (95%CI 1.4-2.9) for rosiglitazone-pioglitazone, and pioglitazone respectively. The clinical decision should be balanced with the risks described earlier with pioglitazone use, being one of the most relevant the increased risk of bladder cancer (HR of 2.642; 95%CI: 1,106, 6.31, p=0.029) with a number needed to harm of 1200. This data emphasizes the need of suitable assessment of fibrosis, to promote pioglitazone in highly selected patients, which will offer better benefits, reducing exposure to potential adverse effects. Finally, the references in the figures are incorrect, being difficult to follow the original sources.