Risk of hepatic events associated with use of sodium-glucose cotransporter-2 inhibitors versus glucagon-like peptide-1 receptor agonists, and thiazolidinediones among patients with metabolic dysfunction-associated steatotic liver disease

🥇 Top 1% JournalSep 6, 2024Gut

Risk of liver problems linked to diabetes drugs in patients with fatty liver disease

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Abstract

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.

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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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Abstract

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