한빛사논문
성균관대학교
Sungho Bea,1,2 Hwa Yeon Ko2, Jae Hyun Bae,3 Young Min Cho,4 Yoosoo Chang,5 Seungho Ryu,6 Christopher D Byrne,7 Ju-Young Shin2
1Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
2School of Pharmacy, Sungkyunkwan University, Suwon, Korea (the Republic of)
3Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (the Republic of)
4Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
5Kangbuk Samsung Hospital, Seoul, Korea (the Republic of)
6Center for Cohort Study, Kangbuk Samsung Hospital, Seoul, Korea (the Republic of)
7Nutrition and Metabolism, University of Southampton, Southampton, UK
SB and HYK contributed equally.
SB and HYK are joint first authors.
Correspondence to Dr Ju-Young Shin
Abstract
Objective: To examine the hepatic effectiveness of sodium-glucose cotransporter-2 inhibitors (SGLT-2i) through a head-to-head comparison with glucagon-like peptide-1 receptor agonists (GLP-1RA) or thiazolidinediones (TZD) in patients with metabolic dysfunction-associated steatotic liver disease (MASLD).
Design: This population-based cohort study was conducted using a nationwide healthcare claims database (2014-2022) of Korea. We included individuals with MASLD (aged ≥40 years) who initiated SGLT-2i or comparator drugs (GLP-1RA or TZD). Primary outcome was a composite of hepatic decompensation events, including ascites, oesophageal varices with bleeding, hepatic failure or liver transplant. Liver-cause death and all-cause death were also assessed as secondary outcomes. Cox proportional hazards models were used to estimated HRs with 95% CIs.
Results: After 1:1 propensity score matching, we included 22 550 patients who initiated SGLT-2i and GLP-1RA (median age=57 years, 60% male), and 191 628 patients who initiated SGLT-2i and TZD (median age=57 years, 72% male). Compared with GLP-1RA, SGLT-2i showed a similar risk of hepatic decompensation events (HR 0.93, 95% CI 0.76 to 1.14). Compared with TZD, SGLT-2i demonstrated a reduced risk of hepatic decompensation events (HR 0.77, 95% CI 0.72 to 0.82). As compared with TZD, the results of secondary analyses showed significantly lower hepatic decompensation event risks with SGLT-2i when stratified by sex (male: HR 0.87 (95% CI 0.80-0.94); female: HR 0.62 (95% CI 0.55-0.69)).
Conclusions: In this nationwide cohort study, SGLT-2i was associated with a lower risk of hepatic decompensation events in patients with MASLD compared with TZD, while demonstrating similar effectiveness to GLP-1RA.
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