In a cohort of 22,550 patients, SGLT-2 inhibitors were associated with a lower risk of hepatic decompensation events compared to .
SGLT-2 inhibitors showed a reduced risk of hepatic decompensation events compared to thiazolidinediones, with a hazard ratio of 0.77.
The risk of hepatic decompensation events with SGLT-2 inhibitors was similar to that of , indicated by a hazard ratio of 0.93.
When stratified by sex, male patients on SGLT-2 inhibitors had a hazard ratio of 0.87 for hepatic decompensation events, while female patients had a hazard ratio of 0.62.
The primary outcome measured was a composite of serious liver-related events, including ascites, bleeding varices, and liver failure.
Simplified
OBJECTIVE: To examine the hepatic effectiveness of (SGLT-2i) through a head-to-head comparison with (GLP-1RA) or (TZD) in patients with (MASLD).
DESIGN: This population-based cohort study was conducted using a nationwide healthcare claims database (2014-2022) of Korea. We included individuals with MASLD (aged ≥40 years) who initiated SGLT-2i or comparator drugs (GLP-1RA or TZD). Primary outcome was a composite of hepatic decompensation events, including ascites, oesophageal varices with bleeding, hepatic failure or liver transplant. Liver-cause death and all-cause death were also assessed as secondary outcomes. Cox proportional hazards models were used to estimated HRs with 95% CIs.
RESULTS: After 1:1 propensity score matching, we included 22 550 patients who initiated SGLT-2i and GLP-1RA (median age=57 years, 60% male), and 191 628 patients who initiated SGLT-2i and TZD (median age=57 years, 72% male). Compared with GLP-1RA, SGLT-2i showed a similar risk of hepatic decompensation events (HR 0.93, 95% CI 0.76 to 1.14). Compared with TZD, SGLT-2i demonstrated a reduced risk of hepatic decompensation events (HR 0.77, 95% CI 0.72 to 0.82). As compared with TZD, the results of secondary analyses showed significantly lower hepatic decompensation event risks with SGLT-2i when stratified by sex (male: HR 0.87 (95% CI 0.80-0.94); female: HR 0.62 (95% CI 0.55-0.69)).
CONCLUSIONS: In this nationwide cohort study, SGLT-2i was associated with a lower risk of hepatic decompensation events in patients with MASLD compared with TZD, while demonstrating similar effectiveness to GLP-1RA.
Key numbers
0.77
Lower risk of
Hazard Ratio comparing vs.
0.93
Similar risk of
Hazard Ratio comparing vs.
0.62
Greater benefit in females
Hazard Ratio for female patients using
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Competing interests: J-YS received grants from the Ministry of Food and Drug Safety, the Ministry of Health and Welfare, the National Research Foundation of Korea, and pharmaceutical companies, including LG Chem, UCB, SK bioscience and Pfizer, outside the submitted work.
