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.
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。