Abstract：
OBJECTIVE: To compare the effectiveness of sodium-glucose co-transporter-2 inhibitors (SGLT2is) with dipeptidyl peptidase-4 inhibitors (DPP4is) on major liver outcomes (MLO) in patients with type 2 diabetes (T2D) and metabolic dysfunction-associated steatotic liver disease (MASLD).
METHODS: We included adult patients with T2D and MASLD, using metformin without specific liver conditions or surgeries, from the Merative MarketScan database. Patients initiating SGLT2is or DPP4is from 1 January 2014 to 31 December 2022 were identified. The primary outcome was time to MLO diagnosis. Overlap weighting balanced covariates, integrated with a Cox proportional hazards model for survival analysis.
RESULTS: Among 44 651 patients, 22 100 initiated SGLT2is, and 22 551 began DPP4is. After weighting, the incidence rate of MLO in the SGLT2i group was 3.8 per 1000 person-years, and it was 3.9 per 1000 person-years in the DPP4i group, resulting in an adjusted hazard ratio (aHR) of 0.82 (95% CI, 0.60-1.10). SGLT2i initiation was not associated with cirrhosis (aHR: 0.77; 95% CI, 0.55-1.06) or hepatocellular carcinoma (aHR: 0.99; 95% CI, 0.47-1.83) separately. Subgroup and sensitivity analyses did not yield significant results.
CONCLUSIONS: In patients with T2D and MASLD, SGLT2is did not show a lower risk of MLO compared with DPP4is. Clinicians should consider the overall patient conditions and the additional benefits of SGLT2is to support the decision to switch from DPP4is.
METHODS: We included adult patients with T2D and MASLD, using metformin without specific liver conditions or surgeries, from the Merative MarketScan database. Patients initiating SGLT2is or DPP4is from 1 January 2014 to 31 December 2022 were identified. The primary outcome was time to MLO diagnosis. Overlap weighting balanced covariates, integrated with a Cox proportional hazards model for survival analysis.
RESULTS: Among 44 651 patients, 22 100 initiated SGLT2is, and 22 551 began DPP4is. After weighting, the incidence rate of MLO in the SGLT2i group was 3.8 per 1000 person-years, and it was 3.9 per 1000 person-years in the DPP4i group, resulting in an adjusted hazard ratio (aHR) of 0.82 (95% CI, 0.60-1.10). SGLT2i initiation was not associated with cirrhosis (aHR: 0.77; 95% CI, 0.55-1.06) or hepatocellular carcinoma (aHR: 0.99; 95% CI, 0.47-1.83) separately. Subgroup and sensitivity analyses did not yield significant results.
CONCLUSIONS: In patients with T2D and MASLD, SGLT2is did not show a lower risk of MLO compared with DPP4is. Clinicians should consider the overall patient conditions and the additional benefits of SGLT2is to support the decision to switch from DPP4is.
摘要：
目的：比较钠-葡萄糖协同转运体-2抑制剂（SGLT2is）和二肽基肽酶-4抑制剂（DPP4is）对2型糖尿病（T2D）和代谢功能障碍相关的脂肪变性肝病（MASLD）患者的主要肝脏结局（MLO）的有效性。
方法：我们纳入了患有T2D和MASLD的成年患者，使用二甲双胍没有特定的肝脏疾病或手术，从MerativeMarketScan数据库。确定了从2014年1月1日至2022年12月31日开始使用SGLT2is或DPP4is的患者。主要结果是MLO诊断的时间。重叠加权平衡协变量，结合Cox比例风险模型进行生存分析。
结果：在44651名患者中，22100启动SGLT2is，22551开始DPP4is。加权后，SGLT2i组MLO发生率为3.8/1000人年，在DPP4i组中是每1000人年3.9，导致调整后的风险比（aHR）为0.82（95%CI，0.60-1.10）。SGLT2i启动与肝硬化（aHR：0.77;95％CI，0.55-1.06）或肝细胞癌（aHR：0.99;95％CI，0.47-1.83）无关。亚组和敏感性分析没有产生显著结果。
结论：在T2D和MASLD患者中，SGLT2is与DPP4is相比，未显示较低的MLO风险。临床医生应考虑患者的总体状况和SGLT2is的额外益处，以支持从DPP4is转换的决定。
方法：我们纳入了患有T2D和MASLD的成年患者，使用二甲双胍没有特定的肝脏疾病或手术，从MerativeMarketScan数据库。确定了从2014年1月1日至2022年12月31日开始使用SGLT2is或DPP4is的患者。主要结果是MLO诊断的时间。重叠加权平衡协变量，结合Cox比例风险模型进行生存分析。
结果：在44651名患者中，22100启动SGLT2is，22551开始DPP4is。加权后，SGLT2i组MLO发生率为3.8/1000人年，在DPP4i组中是每1000人年3.9，导致调整后的风险比（aHR）为0.82（95%CI，0.60-1.10）。SGLT2i启动与肝硬化（aHR：0.77;95％CI，0.55-1.06）或肝细胞癌（aHR：0.99;95％CI，0.47-1.83）无关。亚组和敏感性分析没有产生显著结果。
结论：在T2D和MASLD患者中，SGLT2is与DPP4is相比，未显示较低的MLO风险。临床医生应考虑患者的总体状况和SGLT2is的额外益处，以支持从DPP4is转换的决定。
