The beneficial hepatic effects of glucagon-like peptide 1 receptor agonists in patients with diabetes and metabolic dysfunction-associated steatotic liver disease are independent of weight loss

Liver cancer international Pub Date : 2024-07-15 DOI:10.1002/lci2.86

Roberta Forlano, Huma Malik, Benjamin H. Mullish, Michael Yee, Chioma Izzi-Engbeaya, Pinelopi Manousou

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Abstract

Background

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disease worldwide. Despite resmetirom being recently approved for treatingnon-cirrhotic MASH patients in the United States of America (but not elsewhere), weight loss and lifestyle remain the first line and mainstay for treating the condition. Glucagon-like peptide 1 receptor agonists (GLP-1RAs) have shown promise in MASLD treatment, as they promote significant weight loss.

Aims

In this study, we assessed the effect of long-term GLP-1 therapy on liver disease severity in a cohort of patients with Type 2 diabetes and MASLD.

Materials and methods

In this retrospective observational study, we included all new MASLD patients seen in the liver clinic (Imperial College Healthcare NHS Trust) from January 2010 to May 2022. Demographic, anthropometric and clinical data were collected at baseline and at the most recent follow-up.

Results

779 patients were included. Among those with Type 2 diabetes mellitus (T2DM) (n = 335), 94 (28%) were prescribed a GLP-1RA for a median period of 38 (1–171.2) months. In those on GLP-1RA, there was a significant improvement in BMI (33.1 vs. 34.9 kg/m², p = 0.005), alanine aminotransferase (ALT) (37 vs. 58 IU/L, p = 0.009), HbA1c (58 vs. 61 mmol/lL, p = 0.006) and CAP score (331 vs. 354 dB/m, p = 0.0001) at the end of follow-up. Finally, among those who were treated with GLP-1RA, 37 patients had <5% weight loss over a median of 38 (10–134) months. In this group, there was also a significant reduction in ALT (32 vs. 58 IU/L, p = 0.0001), AST (30 vs. 36 IU/L, p = 0.004) and CAP score (329 vs. 349 dB/m, p = 0.05) compared with those who lost >5% weight. In this real-life cohort of patients with diabetes and MASLD, treatment with GLP-1RA was associated with greater weight loss and hepatic fat reduction. Of note, a reduction in fat content was observed also in those who did not lose weight.

Conclusion

Treatment with GLP-1RA should be favoured when treating patients with co-existing diabetes and MASLD.

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胰高血糖素样肽 1 受体激动剂对糖尿病和代谢功能障碍相关脂肪性肝病患者肝脏的有益作用与体重减轻无关

背景代谢功能障碍相关性脂肪性肝病（MASLD）是全球发病率最高的慢性肝病。尽管雷美替罗最近被批准用于治疗非肝硬化的 MASH 患者，但减肥和生活方式仍是治疗该病的首选和主要方法。胰高血糖素样肽 1 受体激动剂（GLP-1RAs）可显著减轻体重，因此在 MASLD 治疗中大有可为。目的在本研究中，我们评估了长期 GLP-1 治疗对 2 型糖尿病合并 MASLD 患者肝病严重程度的影响。材料与方法在这项回顾性观察研究中，我们纳入了 2010 年 1 月至 2022 年 5 月期间在帝国理工学院医疗保健 NHS 信托基金会肝病诊所就诊的所有新 MASLD 患者。我们收集了基线和最近一次随访时的人口统计学、人体测量和临床数据。结果共纳入 779 名患者。在2型糖尿病（T2DM）患者（n = 335）中，94人（28%）服用了GLP-1RA，服用时间中位数为38（1-171.2）个月。在使用 GLP-1RA 的患者中，随访结束时体重指数（33.1 vs. 34.9 kg/m2，p = 0.005）、丙氨酸氨基转移酶（ALT）（37 vs. 58 IU/L，p = 0.009）、HbA1c（58 vs. 61 mmol/lL，p = 0.006）和 CAP 评分（331 vs. 354 dB/m，p = 0.0001）均有显著改善。最后，在接受 GLP-1RA 治疗的患者中，有 37 名患者的体重在中位数 38（10-134）个月内下降了 5%。与体重减轻<5%的患者相比，这组患者的谷丙转氨酶（ALT）（32 对 58 IU/L，p = 0.0001）、谷草转氨酶（AST）（30 对 36 IU/L，p = 0.004）和 CAP 评分（329 对 349 dB/m，p = 0.05）也显著下降。在这个真实的糖尿病和 MASLD 患者队列中，使用 GLP-1RA 治疗与体重减轻和肝脏脂肪减少有关。值得注意的是，在体重未减轻的患者中也观察到了脂肪含量的减少。结论在治疗同时患有糖尿病和 MASLD 的患者时，应首选 GLP-1RA 治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Liver cancer international

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