GLP-1RAs Linked to Lower Risk for Cirrhosis in Patients with MASLD, Type 2 Diabetes: Daily Dose

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This week, we reported on findings from a study presented at Digestive Disease Week (DDW) 2024, May 18-21, 2024, in Washington, DC that examined whether glucagon-like peptide-1 (GLP-1) agonists prevent progression of cirrhosis and hepatocellular carcinoma (HCC) in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) and type 2 diabetes (T2D).

The study

Researchers identified all adults with T2D and comorbid MASLD who sought care at 129 hospitals in the US Veterans Affairs health care system. Each patient who initiated GLP-1 agonist treatment (users) was matched with up to 50 patients who did not receive GLP-1 agonists (non-users) from the same cohort. The date of first prescription was used as the index date for follow-up.

For the primary analysis, researchers excluded patients with prevalent cirrhosis, which was defined for the purpose of the study as a FIB-4 score >2.67 or based on ICD-10 codes, or HCC any time before or 6 months after index date. To balance potential confounders such as income, disability, and demographics, they applied propensity score weighting. The main outcome was the time from the index date to cirrhosis or HCC, whichever occurred first.

The findings

A total of 23 670 patients with T2D and MASLD using GLP-1 agonists were identified, along with 169 646 matched non-users, and followed for a median of 20 months. Among the patients who used GLP-1 agonists, 70% were on semaglutide, 13% were on liraglutide, and 17% used both.

Results showed that GLP-1 agonist users had a lower annual incidence of cirrhosis or HCC (0.82%) than non-users (2.3%) (adjusted HR [aHR] 0.29, 95% CI 0.26-0.32). Also, participants who used GLP-1 agonists had a reduced risk of HCC compared to non-users (annual incidence 0.02% vs 0.05%, aHR 0.36, 95% CI 0.17-0.76).

Authors' comment

“With the increasing prevalence of MASLD and the advent of new non-invasive diagnostics, the management of MASLD must expand beyond the hepatologist to gastroenterologists, endocrinologists and primary care providers. Having therapies that these specialties are already comfortable with that address not only cardiometabolic risk but also liver-related outcomes could simplify the management of these patients."

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