If the heterogeneity was above 50% or the P-value was less than 0.10, Dasatinib mw we planned to explore for the source of heterogeneity and perform appropriate sensitivity analyses. The presence of publication bias was assessed by visual inspection of funnel plots, generated by revman 5, of the primary outcomes reported in the included studies. Subgroup analyses with summary effects were performed for each GH axis drug studied. As depicted in Table 1, all 10 included studies were randomized double-blinded placebo-controlled
studies. The duration of the intervention in the studies ranged from 12 to 26 weeks. Six studies evaluated GH as their primary intervention, four studies evaluated tesamorelin, one study evaluated GHRH, and one evaluated IGF-1. One article compared two interventions (GH and IGF-1) vs. a placebo group. As can be seen in Figure 1, the summary effect shows that GH axis drugs produced a significant reduction in VAT compared with placebo (WMD –25.20 cm2; 95% CI −32.18 to –18.22 cm2; P<0.001). Statistically significant reductions were found for GH (WMD −32.61 cm2; 95% CI −41.82 to –23.40 cm2; P<0.001) and tesamorelin
(WMD −22.65 cm2; 95% CI −32.67 to −12.64 cm2; P<0.001). GHRH Epigenetic inhibitors library treatment did not result in a statistically significant decrease in VAT (WMD −21.50 cm2; 95% CI −44.28 to 1.28 cm2; P=0.06). As shown in Figure 2, compared with placebo, GH axis drugs significantly reduced SAT mass (WMD –3.94 cm2; 95% CI −10.88 to 3.00 cm2; P=0.02). Subgroup analyses showed that no significant decrease in SAT mass was found with tesamorelin (WMD 1.02 cm2; 95% CI –8.21 to 6.16 cm2; P=0.78) or GHRH (WMD –1.40 cm2; 95% CI –13.55 to 10.75 cm2; acetylcholine P=0.82).
However, GH treatment did result in a statistically significant decrease in SAT compared with placebo (WMD –16.02 cm2; 95% CI –24.08 to –7.97 cm2; P<0.001). As shown in Figure 3, GH axis drugs produced a significant change in LBM compared with placebo (WMD 1.31 kg; 95% CI 1.00 to 1.61 kg; P<0.001). Subgroup analysis showed that there was a significant increase in LBM with tesamorelin (WMD 1.35 kg; 95% CI 1.03 to 1.66 kg; P<0.001) and GHRH (WMD 0.78 kg; 95% CI –0.39 to 1.95 kg; P=0.019), while GH (WMD 1.51 kg; 95% CI –0.22 to 3.24 kg; P=0.09) and IGF-1 (WMD 2.05 kg; 95% CI –0.08 to 4.18 kg; P=0.06) did not produce a significant gain. GH axis drugs had an overall effect of increasing fasting plasma glucose (WMD 2.88 mg/dL; 95% CI 1.10 to 4.65 mg/dL; P=0.001), decreasing waist circumference (WMD −1.61 cm; 95% CI –2.33 to –0.89 cm; P<0.001), decreasing extremity fat (WMD –0.25 kg; 95% CI –0.49 to 0.01 kg; P=0.04), and decreasing triglycerides (WMD –25.37 mg/dL; 95% CI –46.84 to –3.89 mg/dL; P=0.02).