68 - Use of GLP1 Agonists or SGLT2 Inhibitors in Non-Alcoholic Steatohepatitis Patients With T2DM Is Associated With a Lower Risk of Cirrhosis: A Nationwide Population-Based Study

Wednesday, October 26, 2022

9:15 AM – 9:30 AM ET

Location: Hall C1

Presenting Author(s)

Ahmed Eltelbany, MD, MPH

Cleveland Clinic
Cleveland, OH

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Ahmed Eltelbany, MD, MPH, Osama Hamid, MD, MRCPI, Khaled Alsabbagh Alchirazi, MD, Abdul Mohammed, MD, Omar Massoud, MD
Cleveland Clinic, Cleveland, OH

Introduction: Non-alcoholic steatohepatitis (NASH) is becoming increasingly prevalent and a leading cause of cirrhosis. Unfortunately, besides lifestyle changes, therapeutic options specifically targeting NASH are limited. Previous single center studies have suggested that glucagon-like peptide receptor (GLP1) agonists and sodium glucose co-transporter-2 (SGLT2) inhibitors may have a beneficial effect. We sought to investigate the prevalence of cirrhosis among NASH patients with type 2 diabetes mellitus (T2DM) who received GLP1 agonists or SGLT2 inhibitors in a large population-based study.

Methods: We used the Explorys clinical database which includes over 74 million de-identiﬁed unique patients across 300 hospitals in the United States. Patient were identiﬁed using SNOMED and ICD codes. We identified all patients (age >18 years) who were diagnosed with type 2 diabetes mellitus T2DM and NASH. Exclusion criteria included history of hepatitis B or C, alcoholic cirrhosis, hemochromatosis, alpha1-antitrypsin deficiency, cystic fibrosis, and Wilson’s disease. We investigated the prevalence of cirrhosis in NASH patients with and without GLP1 Agonists and SGLT2 Inhibitors therapy. Odds ratios with 95% conﬁdence intervals were calculated to evaluate the risk of cirrhosis.

Results: We identified 29,220 NASH patients with T2DM, of whom 5,120 (17.5%) and 3,850 (13.2%) received GLP1 agonists or SGLT2 inhibitors, respectively. 12,630 (43.2%) patients had a diagnosis of cirrhosis. Patients who received GLP1 agonists or SGLT2 inhibitors were more likely to be Caucasian [OR: 1.64; 95%CI: 1.52 – 1.77] and younger than 65 years [OR: 1.59; 95%CI: 1.51 – 1.68] (Table 1). There was no statistically significant gender-based difference identified. Use of GLP1 agonists or SGLT2 inhibitors was associated with a significantly lower risk of cirrhosis [OR: 0.83; 95%CI 0.79 – 0.88]. Sub-group analysis revealed that patients who received SGLT2 inhibitors had the lowest risk of developing cirrhosis [OR: 0.76; 95%CI 0.71 – 0.81] (Figure 1).

Discussion: In this large retrospective study, we found that the use of GLP1 Agonists and SGLT2 Inhibitors in NASH patients with T2DM was associated with a significantly lower risk of cirrhosis. Furthermore, patients who received SGLT2 inhibitors were associated with the lowest risk of cirrhosis. Further prospective studies are needed to determine whether GLP1 agonists and SGLT2 Inhibitors may mitigate cirrhosis risk in NASH.

Figure: Figure 1: Logistic regression of cirrhosis risk with GLP1 agonists and SGLT2 inhibitors in NASH patients with T2DM.

Variable	Patients who received GLP1/SGLT2				Patients without Cirrhosis
	With Cirrhosis	%	Without Cirrhosis	%	Patients without Cirrhosis
N	2,790		4,300		16590	%
Age 18 - 64	1420	50.9%	2,860	66.5%	9,660	58.2%
Age >65	1390	49.8%	1,460	34.0%	7,010	42.3%
Caucasian	2,490	89.2%	3,650	84.9%	12,940	78.0%
Hyperlipidemia	2,400	86.0%	3,950	91.9%	14,110	85.1%
HTN	1010	36.2%	1660	38.6%	5,050	30.4%
Obesity	2170	77.8%	3,380	78.6%	11,140	67.1%
Obstructive Sleep Apnea	1340	48.0%	2,040	47.4%	6,350	38.3%
Hypothyroidism	990	35.5%	1,330	30.9%	4,760	28.7%
PCOS	90	3.2%	220	5.1%	620	3.7%

Table: Table 1: Demographics of patients. HTN; Essential hypertension, PCOS; polycystic ovary syndrome

Disclosures:

Ahmed Eltelbany indicated no relevant financial relationships.

Osama Hamid indicated no relevant financial relationships.

Khaled Alsabbagh Alchirazi indicated no relevant financial relationships.

Abdul Mohammed indicated no relevant financial relationships.

Omar Massoud indicated no relevant financial relationships.

Ahmed Eltelbany, MD, MPH, Osama Hamid, MD, MRCPI, Khaled Alsabbagh Alchirazi, MD, Abdul Mohammed, MD, Omar Massoud, MD, 68, Use of GLP1 Agonists or SGLT2 Inhibitors in Non-Alcoholic Steatohepatitis Patients With T2DM Is Associated With a Lower Risk of Cirrhosis: A Nationwide Population-Based Study, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.