Preliminary comparison of major adverse outcomes in patients with nonalcoholic fatty liver disease initiated on second-line antihyperglycemic therapy

Date
2023
DOI
Authors
Kim, Rachel Soon-yong
Version
OA Version
Citation
Abstract
OBJECTIVES: To assess long-term hepatic and cardiovascular outcomes in patients with both nonalcoholic fatty liver disease (NAFLD) and type II diabetes who are initiated on treatment with second-line antihyperglycemic medications including sodium-glucose contransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA). METHODS: This retrospective cohort study included patients with NAFLD and type II diabetes queried from the electronic health record of the Mass General Brigham healthcare system. Previous work by our team has created a dataset of patients with NAFLD identified from liver biopsy reports using natural language processing techniques. This was further subdivided into three cohorts based on initiation of a second-line diabetes medication. Patients were followed in an as-treated approach for liver decompensation events (i.e., ascites, spontaneous bacterial peritonitis, hepatorenal syndrome, bleeding esophageal varices, or hepatic encephalopathy), hepatocellular carcinoma, major adverse cardiovascular events (i.e., myocardial infarction, stroke, bleeding event, or congestive heart failure), and death. Incidence rates of these outcomes were compared between the three groups. RESULTS: The incidence rate of adverse events was much lower in patients initiated on SGLT2i or GLP-1RA as compared to insulins, sulfonylureas, thiazolidinediones, or dipeptidyl peptidase-4 inhibitors. The SGLT2i and GLP-1RA cohorts were comparable with 0.20 and 0.19 events per 1,000 person-years, respectively. The other medication cohort had an event rate of 1.01 events per 1,000 person-years. CONCLUSION: Preliminary findings suggest that SGLT2i and GLP-1RA therapy may have a protective role in NAFLD patients. However, this analysis did not control for any confounding between the treatment groups. More robust comparisons are underway and will be reported in future publications.
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