Introduction & Objective: Metabolic-dysfunction associated steatohepatitis (MASH; or NASH) affects 3-6% of adults in the US; many also receive GLP1 for type II diabetes mellitus (T2DM) and/or obesity. This study aimed to characterize clinical and economic outcomes among patients with MASH and T2DM with vs. without GLP1s; overall, and among patients with obesity and/or baseline cirrhosis.

Methods: Optum de-identified Clinformatics® Data Mart Database (2015-2022) was used to identify adults with NASH and T2DM. At baseline, patients with vs. without GLP1 use were matched 1:1 on age, sex, and diabetes complications severity index. Prevalence of a composite clinical outcome (mortality, liver transplant, +/- significant hepatic event) and mean total costs per patient per year (PPPY) were estimated and presented for patients overall, who were overweight/obese, and/or had baseline cirrhosis.

Results: NASH patients with T2DM on GLP1s (n=1,268) had a similar length of follow-up and prevalence of the composite outcome as patients without GLP1 (n=1,268; 30 vs. 33 months; 52% vs. 51%). Higher costs PPPY were observed among patients on GLP1s ($78k vs. $72k). This difference was driven by higher pharmacy costs ($11k) with lower medical costs ($5k) among GLP1 users. When restricted to patients overweight/obese, total PPPY costs and prevalence of composite outcome remained higher for GLP1 users; and the prevalence of composite outcome and total costs PPPY were consistently higher for patients with cirrhosis (87%-92%; mean $118k-$134k) vs without cirrhosis (19%-31%; $36k-$53k).

Conclusion: Irrespective of GLP1 treatment among MASH patients with T2DM, those with cirrhosis had worse clinical and economic outcomes. While this analysis did not restrict to indication for GLP1 use, end-stage liver disease events remain an unmet need for all MASH patients regardless of GLP1 use. Therapies that slow progression to cirrhosis are needed.

Disclosure

Y. Kim: Employee; Madrigal Pharmaceuticals, Inc. C. Qian: None. J. Fishman: Employee; Madrigal Pharmaceuticals, Inc. S.M. Szabo: None. H. Rochon: None. R. Sun: None. J. Medicis: Employee; Madrigal Pharmaceuticals, Inc. M. Charlton: Consultant; Madrigal Pharmaceuticals, Inc., 89bio, Inc., Novo Nordisk, Merck & Co., Inc., Sagimet Biosciences, Bristol-Myers Squibb Company, Novartis AG, Pfizer Inc., Terns Pharmaceuticals, Siemens Healthcare Diagnostics.

© 2024 by the American Diabetes Association
2024
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