Association of GLP-1 Receptor Agonists with Liver-Related Outcomes and All-Cause Mortality in Patients with Harmful Alcohol Use: A Target Trial Emulation Study.

IF 8 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
Binu V John, Dustin Bastaich, Daniella Marchetti, Ponni Perumalswami, Mixael Zirio Mustafa, Bassam Dahman
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引用次数: 0

Abstract

Background and aims: Anecdotal observations report a decrease in craving for alcohol among patients taking glucagon-like peptide-1 receptor agonists (GLP-1RA). We aimed to assess liver-related outcomes and mortality among individuals with harmful alcohol use who received GLP-1 RAs.

Methods: We emulated a target trial using the electronic health records of U.S. Veterans with positive alcohol use disorders-concise score (AUDIT-C), comparing new initiators of GLP-1RA between 1/3/2017 and 9/30/2024, with controls, with follow-up until outcomes or study end. Each GLP-1 RA new user with a positive AUDIT-C screen was propensity score-matched 1:1 with a patient not on a GLP-1RA. The primary outcomes were the time to a composite outcome of decompensation, HCC, liver-related death, and all-cause mortality. The secondary outcome was the proportion of patients with positive AUDIT-C scores.

Results: We matched 8040 patients with positive AUDIT-C initiated on GLP-1 RA with 8040 non-initiators. GLP-1 RA use was associated with a lower risk of composite liver-related outcomes (adjusted hazard ratio [aHR], 0.70; 95% CI 0.56-0.87), and death (aHR 0.43, 95% CI 0.37-0.49). Among Semaglutide users, a 1 mg/week dose increase was associated with a reduced risk of composite liver-related outcomes (aHR 0.50, 95% CI 0.29-0.88) and death (aHR 0.33, 95% CI 0.19-0.58). GLP-1 RA use was also associated with lower odds of positive AUDIT-C during follow-up (aOR 0.75, 95% CI 0.68-0.82).

Conclusions and relevance: In this observational target trial emulation study, GLP-1 RA use was associated with a lower risk of liver outcomes, death, and harmful alcohol use.

GLP-1受体激动剂与有害酒精使用患者肝脏相关结局和全因死亡率的关联:一项目标试验模拟研究
背景和目的:轶事观察报告,服用胰高血糖素样肽-1受体激动剂(GLP-1RA)的患者对酒精的渴望减少。我们的目的是评估接受GLP-1 RAs治疗的有害酒精使用个体的肝脏相关结局和死亡率。方法:我们模拟了一项目标试验,使用美国酒精使用障碍阳性退伍军人的电子健康记录-简明评分(AUDIT-C),比较2017年3月1日至2024年9月30日期间GLP-1RA的新启动者与对照组,并随访至结果或研究结束。每个审计- c筛查阳性的GLP-1RA新用户与未使用GLP-1RA的患者的倾向评分匹配为1:1。主要结局是到失代偿、HCC、肝脏相关死亡和全因死亡率的复合结局的时间。次要终点是AUDIT-C评分为阳性的患者比例。结果:我们将8040例GLP-1 RA启动的AUDIT-C阳性患者与8040例非启动者进行了匹配。GLP-1 RA的使用与较低的肝脏相关综合结局风险相关(校正风险比[aHR], 0.70;95% CI 0.56-0.87)和死亡(aHR 0.43, 95% CI 0.37-0.49)。在Semaglutide使用者中,剂量增加1mg /周与肝脏相关的复合结局(aHR 0.50, 95% CI 0.29-0.88)和死亡(aHR 0.33, 95% CI 0.19-0.58)的风险降低相关。GLP-1 RA的使用也与随访期间AUDIT-C阳性的较低几率相关(aOR 0.75, 95% CI 0.68-0.82)。结论和相关性:在这项观察性目标试验模拟研究中,GLP-1 RA的使用与较低的肝脏结局、死亡和有害酒精使用风险相关。
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来源期刊
American Journal of Gastroenterology
American Journal of Gastroenterology 医学-胃肠肝病学
CiteScore
11.40
自引率
5.10%
发文量
458
审稿时长
12 months
期刊介绍: Published on behalf of the American College of Gastroenterology (ACG), The American Journal of Gastroenterology (AJG) stands as the foremost clinical journal in the fields of gastroenterology and hepatology. AJG offers practical and professional support to clinicians addressing the most prevalent gastroenterological disorders in patients.
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