JAMA Intern Med

GLP-1 agonists may improve outcomes in MASLD

September 30, 2024

Among patients with metabolic dysfunction-associated steatotic liver disease (MASLD) and diabetes, GLP-1 agonist use was associated with a lower risk of progression to cirrhosis and mortality. However, the chemopreventive benefit wasn’t seen among patients who’d already progresses to cirrhosis.

This retrospective cohort study included patients with MASLD and diabetes who were seen at 130 VA hospitals/ambulatory clinics and who initiated either a GLP-1 RA or DPP-4i between January 2006 and June 2022. Patients were followed from baseline until one of the study outcomes or the end of the study period (December 31, 2022), whichever came first. For patients without cirrhosis at baseline, primary outcome was progression to cirrhosis, and secondary outcomes were cirrhosis complications defined both as a composite and individual complications, including decompensation, hepatocellular carcinoma, or liver transplant, and all-cause mortality.

Of 16,058 GLP-1 RA initiators, 14,606 didn’t have cirrhosis (mean age, 60.56 years; 89.1% male), and 1,452 had cirrhosis (mean age, 66.99 years; 93.7% male) at baseline. These patients were matched to an equal number of DPP-4i initiators. In patients without baseline cirrhosis, GLP-1 RA use (vs. DPP-4i use) was associated with a lower risk of cirrhosis (9.98 vs. 11.10 events per 1,000 person-years; hazard ratio [HR], 0.86; 95% CI, 0.75-0.98). Similar results were seen for secondary outcomes. GLP-1 RA use (vs. DPP-4i use) was associated with a lower risk of the composite outcome of cirrhosis complications (1.89 vs. 2.55 events per 1,000 person-years; HR, 0.78; 95% CI, 0.59-1.04) and mortality (21.77 vs. 24.43 events per 1000 person-years; HR, 0.89; 95% CI, 0.81-0.98). No associations were seen between GLP-1 RA use and outcomes in patients with cirrhosis.

Source:

Kanwal F, et al. (2024, September 16). JAMA Intern Med. GLP-1 Receptor Agonists and Risk for Cirrhosis and Related Complications in Patients With Metabolic Dysfunction-Associated Steatotic Liver Disease. https://pubmed.ncbi.nlm.nih.gov/39283612/