GLP-1RAs may improve long-term liver outcomes in T2D patients with MASLD

For patients with type 2 diabetes (T2D) and metabolic dysfunction-associated steatotic liver disease (MASLD) cirrhosis, treatment with glucagon-like peptide-1 receptor agonists helps reduce the risk of hepatic decompensation, portal hypertension, hepatocellular carcinoma, and liver transplantation, according to a study.

The retrospective cohort study included 5,296 patients with T2D and MASLD cirrhosis, among whom 459 were GLP-1RA users while the remaining 4,837 were not (control). The primary outcome was the incidence of any adverse liver outcomes, defined as a composite of hepatic decompensation (ascites, hepatic encephalopathy, hepatorenal syndrome, spontaneous bacterial peritonitis, variceal bleeding), portal hypertension, hepatocellular carcinoma, or liver transplantation. The secondary outcomes were the cause-specific incidence of each of the four individual components of the composite endpoint.

Researchers used Cox proportional hazard models to explore the association between GLP-1RAs initiation and the risk of adverse liver outcomes.

Adverse liver outcomes occurred more frequently in the control group than in the GLP-1RA group. The composite endpoint was documented in 1,411 controls (29.0 percent) over 7,431.7 person years versus only 32 GLP-1RAs users (7 percent) over 586.6 person years (risk rate difference, 13.5 per 100 person-years, 95 percent confidence interval [CI], 11.4–15.7).

In an analysis that applied overlap propensity score weighting, use of GLP-1RAs reduced the risk of adverse liver outcomes by 36 percent compared with nonuse (hazard ratio [HR], 0.64, 95 percent CI, 0.54–0.76).

In terms of secondary outcomes, GLP-1RA use conferred a protective effect on the risk of hepatic decompensation (HR, 0.74, 95 percent CI, 0.61–0.88), portal hypertension (HR, 0.73, 95 percent CI, 0.60–0.88), hepatocellular carcinoma (HR, 0.37, 95 percent CI, 0.20–0.63), and liver transplantation (HR, 0.24, 95 percent CI, 0.12–0.43).