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. No data are available. The corresponding author will provide data from this study upon request.

中文翻译：

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在代谢功能障碍相关脂肪性肝病患者中，使用钠-葡萄糖协同转运蛋白-2 抑制剂与胰高血糖素样肽-1 受体激动剂和噻唑烷二酮类药物相关的肝事件风险


目的 通过与胰高血糖素样肽-1受体激动剂 （GLP-1RA） 或噻唑烷二酮类药物 （TZD） 在代谢功能障碍相关脂肪性肝病 （MASLD） 患者中的头对头比较，探讨钠-葡萄糖协同转运蛋白-2 抑制剂 （SGLT-2i） 的肝脏疗效。设计 这项基于人群的队列研究是使用韩国全国医疗保健索赔数据库 （2014-2022） 进行的。我们纳入了开始使用SGLT-2i或对照药物（GLP-1RA或TZD）的MASLD个体（年龄≥40岁）。主要结局是肝功能失代偿事件的复合结局，包括腹水、食管静脉曲张伴出血、肝衰竭或肝移植。肝因死亡和全因死亡也被评估为次要结局。Cox 比例风险模型用于估计具有 95% CI 的 HR。结果 1：1 倾向评分匹配后，我们纳入了 22 550 例启动 SGLT-2i 和 GLP-1RA 的患者 （中位年龄 = 57 岁，60% 为男性），以及 191 628 例启动 SGLT-2i 和 TZD 的患者 （中位年龄 = 57 岁，72% 为男性）。与 GLP-1RA 相比，SGLT-2i 显示出相似的肝功能失代偿事件风险 （HR 0.93,95% CI 0.76-1.14）。与 TZD 相比，SGLT-2i 显示肝功能失代偿事件的风险降低 （HR 0.77,95% CI 0.72 至 0.82）。与 TZD 相比，二次分析的结果显示，按性别分层时，SGLT-2i 的肝功能失代偿事件风险显著降低（男性：HR 0.87 （95% CI 0.80-0.94）;女性：HR 0.62 （95% CI 0.55-0.69））。结论 在这项全国性队列研究中，与 TZD 相比，SGLT-2i 与 MASLD 患者肝功能失代偿事件的风险较低相关，同时显示出与 GLP-1RA 相似的有效性。没有可用的数据。 通讯作者将根据要求提供本研究的数据。