'SGLT2 inhibitors more effective than thiazolidinediones to prevent liver disease in MASLD

A research team led by Professor Shin Ju-young of Sungkyunkwan University Department of Pharmacy (with co-first authors Dr. Bae Sung-ho and Ph.D candidate Koh Hwa-yeon) has published the results of a study comparing the effectiveness of SGLT2 inhibitors with thiazolidinediones and GLP-1 receptor agonists in patients with metabolic-associated steatotic liver disease (MASLD).

The study, which used big data from the National Health Insurance Service to analyze prescription records of MASLD patients aged 40 and older from 2014 to 2022, was published online Sept. 6 in Gut (IF:23.0, JCI top 2.4 percent), a leading medical journal.

MASLD is caused by metabolic abnormalities associated with fatty liver and is highly prevalent, affecting 60 percent of people with type 2 diabetes.

Early treatment is essential because MASLD is asymptomatic in the early stages, making it easy to miss treatment. As the disease progresses, it can lead to severe liver disease, including cirrhosis and liver failure. However, there has been insufficient research on hypoglycemic agents to prevent liver disease in MASLD patients.

In this study, the researchers compared three classes of hypoglycemic agents—SGLT2 inhibitors, GLP-1 receptor agonists, and thiazolidinediones—and found that SGLT2 inhibitors and GLP-1 receptor agonists did not differ significantly in preventing liver disease. However, SGLT2 inhibitors were associated with a 23 percent lower risk of liver disease than thiazolidinediones. The effect was more pronounced in women and patients under 65.

Professor Shin explained that the study provides substantial evidence for selecting appropriate hypoglycemic agents to prevent liver disease in MASLD patients, emphasizing that SGLT2 inhibitors are more effective than thiazolidinediones, and that further research on GLP-1 receptor agonists is needed.

The study was conducted in collaboration with Professors Bae Jae-hyun and Cho Young-min of the Department of Endocrinology and Metabolism at Seoul National University Hospital, Professors Chang Yoo-soo and Ryu Seung-ho of the Kangbuk Samsung Hospital, and Professor Christopher Byrne of the University of Southampton in the United Kingdom.

It was supported by the National Health Insurance Service’s customized transfer data and Patient-Centered Medical Technology Optimization Research Project.