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

PURPOSE: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at https://doi.org/10.1007/s40200-026-02119-8.