胰高血糖素样肽-1受体激动剂与改善2型糖尿病和代谢功能障碍相关肝病患者的生存率和减少肝脏相关事件相关:一项大型现实世界回顾性研究

IF 3.7 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM
Benjamin D Liu, Mohammed Aly, Cindy Hsin-Ti Lin, Noordeep Panesar, Hannah Hill, Kamran Qureshi
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引用次数: 0

摘要

目的:评估胰高血糖素样肽-1受体激动剂(GLP-1 RAs)或吡格列酮(PGZ)是否与2型糖尿病(T2DM)合并代谢功能障碍相关肝病(MASLD)或脂肪性肝炎(MASH)患者的生存率提高、肝脏相关事件(LRO)减少和代谢结局改善相关。方法:从2006年起,我们使用TriNetX平台使用ICD编码识别T2DM和MASLD/MASH成人(n=558,075)。伴有混淆性肝病、重叠研究药物或减肥手术的患者被排除在外。形成glp -1 RA、PGZ和其他抗糖尿病药物(对照组)三个队列。在1:1倾向得分匹配后,使用Cox比例风险模型和Kaplan-Meier方法进行时间-事件分析。结果:在匹配组中,GLP-1 RAs (n=17,465)与全因死亡率较对照组降低40.9%相关(HR 0.59;结论:在这个庞大的现实世界队列中,GLP-1 RA的使用与T2DM合并MASLD/MASH患者的生存率和肝脏预后的改善有关,特别是在那些没有肝硬化的患者中。PGZ对肝脏有益。这些发现强调了进一步前瞻性研究的潜在重要性,以评估早期GLP-1 RA治疗MASLD/MASH高危糖尿病人群。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Glucagon-like Peptide-1 Receptor Agonists Are Associated With Improved Survival and Reduced Liver-Related Events in Patients With Type 2 Diabetes and Metabolic Dysfunction-Associated Liver Disease: A Large Real-World Retrospective Study.

Objectives: To evaluate whether glucagon-like peptide-1 receptor agonists (GLP-1 RAs) or pioglitazone (PGZ) are associated with improved survival, reduced liver-related outcomes (LROs), and better metabolic outcomes in patients with type 2 diabetes mellitus (T2DM) and metabolic dysfunction-associated liver disease (MASLD) or steatohepatitis (MASH).

Methods: We used the TriNetX platform to identify adults with T2DM and MASLD/MASH from 2006 onward (n = 558 075) using Internation Classification of Diseases codes. Patients with confounding liver diseases, overlapping study medications, or bariatric surgery were excluded. Three exclusive cohorts-GLP-1 RA, PGZ, and other antidiabetic agents (controls)-were formed. After 1:1 propensity score matching, time-to-event analyses were performed using Cox proportional hazards models and Kaplan-Meier methods.

Results: Among matched groups, GLP-1 RAs (n = 17 465) were associated with a 40.9% reduction in all-cause mortality versus controls (hazard ratio [HR] 0.59; P < .0001) and significantly lower rates of LRO (HR 0.77) and liver transplantation (HR 0.33). In contrast, PGZ (n = 1803) showed reduced LRO rates (HR 0.68) but not mortality. In cirrhotic patients, GLP-1 RA was linked to fewer transplant events but did not significantly reduce mortality. GLP-1 RA therapy noted greater reductions in body mass index and hemoglobin A1c relative to controls.

Conclusions: In this large real-world cohort, GLP-1 RA use was associated with improved survival and hepatic outcomes in T2DM patients with MASLD/MASH, particularly among those without established cirrhosis. PGZ exhibited hepatic benefits. These findings highlight the potential importance of further prospective studies to evaluate early GLP-1 RA therapy in this high-risk diabetic population with MASLD/MASH.

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来源期刊
Endocrine Practice
Endocrine Practice ENDOCRINOLOGY & METABOLISM-
CiteScore
7.60
自引率
2.40%
发文量
546
审稿时长
41 days
期刊介绍: Endocrine Practice (ISSN: 1530-891X), a peer-reviewed journal published twelve times a year, is the official journal of the American Association of Clinical Endocrinologists (AACE). The primary mission of Endocrine Practice is to enhance the health care of patients with endocrine diseases through continuing education of practicing endocrinologists.
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