Glucagon-like Peptide-1 Receptor Agonist Use in Patients With Liver Cirrhosis and Type 2 Diabetes

Jun 18, 2023Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association

Use of Glucagon-like Peptide-1 Drugs in People with Liver Scarring and Type 2 Diabetes

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Abstract

The rates of death were 27.46 per 1000 person-years for GLP-1 RA users compared to 55.90 for nonusers.

GLP-1 RA users had a lower risk of mortality with an adjusted hazard ratio of 0.47.
Users of GLP-1 RAs experienced fewer cardiovascular events, with an adjusted hazard ratio of 0.6.
The risk of developing decompensated cirrhosis was reduced for GLP-1 RA users, showing an adjusted hazard ratio of 0.7.
Hepatic encephalopathy occurred less frequently in GLP-1 RA users, with an adjusted hazard ratio of 0.59.
Liver failure risk was also lower in GLP-1 RA users, indicated by an adjusted hazard ratio of 0.54.
A longer duration of GLP-1 RA use was associated with a reduced risk of these adverse outcomes.

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BACKGROUND AND AIMS: Liver cirrhosis is often associated with type 2 diabetes (T2D), but research on treatment of T2D in cirrhotic patients is scarce. We investigated the long-term outcomes of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in patients with T2D and cirrhosis.

METHODS: Using propensity score matching, we selected 467 matched pairs of GLP-1 RA users and nonusers from the National Health Insurance Research Database of Taiwan from January 1, 2008, to December 31, 2019. Multivariable-adjusted Cox proportional hazards models were used to compare the outcomes between GLP-1 RA users and nonusers.

RESULTS: The mean follow-up time was 3.28 and 3.06 years for GLP-1 RA users and nonusers, respectively. The rates of death were 27.46 and 55.90 per 1000 person-years for GLP-1 RA users and nonusers, respectively. The multivariable-adjusted models showed that GLP-1 RA users had lower risks of mortality (adjusted hazard ratio [aHR], 0.47; 95% confidence interval [CI], 0.32-0.69), cardiovascular events (aHR, 0.6; 95% CI, 0.41-0.87), decompensated cirrhosis (aHR, 0.7; 95% CI, 0.49-0.99), hepatic encephalopathy (aHR, 0.59; 95% CI, 0.36-0.97), and liver failure (aHR, 0.54; 95% CI, 0.34-0.85) than nonusers. A longer cumulative duration of GLP-1 RA use had a lower risk of these outcomes than GLP-1 RA nonuse.

CONCLUSIONS: This population-based cohort study showed that GLP-1 RA users exhibited a significantly lower risk of death, cardiovascular events, decompensated cirrhosis, hepatic encephalopathy, and liver failure in patients with T2D and compensated liver cirrhosis. Additional studies are needed to confirm our results.

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Glucagon-like Peptide-1 Receptor Agonist Use in Patients With Liver Cirrhosis and Type 2 Diabetes

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