Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have demonstrated promising effects on liver outcomes. However, comprehensive evidence regarding liver outcomes in direct comparison with thiazolidinediones (TZD) and glucagon-like peptide-1 receptor agonists (GLP1RA), which are recommended in guidelines for patients with non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes (T2D), is still lacking. Using health insurance claims data from South Korea, we established two pairwise 1:1 propensity score (PS)-matched cohorts who initiated SGLT2i, GLP1 RA (cohort #1, median age=57 years, 60% male), or TZD (cohort #2, median age=57 years, 72% male) between January 2014 and December 2022. The primary outcome was a composite of hepatic decompensation events, including ascites, esophageal varices with bleeding, hepatic failure, or liver transplant. Hazard ratios (HR) with 95% confidence intervals (CI) were calculated. In cohort #1, compared to GLP1RA, SGLT2i showed a similar risk of hepatic decompensation events (HR 0.92, 95% CI 0.76-1.12). In cohort #2, compared to TZD, SGLT2i demonstrated a reduced risk of hepatic decompensation events (HR 0.77, 95% CI 0.72-0.82). In this nationwide cohort study, SGLT2i was associated with a reduced risk of hepatic decompensation events in patients with NAFLD and T2D compared to TZDs, showing similar effectiveness to GLP1RA.
S. Bea: None. H. Ko: None. J. Shin: Research Support; Pfizer Inc., Celltrion, SK Bioscience, GlaxoSmithKline plc.
This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: RS-2023-00273553)
