Comparative risk of fibrosis progression with sodium-glucose cotransporter-2 vs. dipeptidyl peptidase-4 inhibitors in metabolic dysfunction-associated steatotic liver disease and type 2 diabetes mellitus with low-to-intermediate fibrosis

Nov 11, 2025Clinical and molecular hepatology

Risk of liver scarring progression with SGLT-2 versus DPP-4 inhibitors in fatty liver disease and type 2 diabetes with mild to moderate scarring

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Abstract

Among 16,901 eligible patients, SGLT2i users experienced fibrosis progression at a rate of 3.46/100 person-years.

  • SGLT2i use was linked to a lower risk of fibrosis progression compared to DPP-4 inhibitors, with a hazard ratio of 0.78.
  • The progression to advanced fibrosis was confirmed on at least two occasions within one year for patients with and T2DM.
  • No significant difference in the incidence of major adverse liver outcomes was found between SGLT2i and DPP-4i users.
  • Subgroup analyses suggested consistent associations in patients using metformin, statins, and aspirin.

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Key numbers

3.46 per 100 person-years
Fibrosis Progression Rate
Rate of fibrosis progression in SGLT2i users
0.78
Hazard Ratio for Fibrosis Progression
Hazard ratio comparing SGLT2i vs. DPP-4i users
4.44 per 100 person-years
Fibrosis Progression Rate in DPP-4i Users
Rate of fibrosis progression in DPP-4i users

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