SGLT-2 inhibitors may avert portal hypertensive complications, death in cirrhosis patients

Use of SGLT-2 inhibitors among patients with cirrhosis helps prevent portal hypertensive complications and improve survival, suggests a study.

Adults with cirrhosis treated with SGLT-2 inhibitors were identified using TriNetX. Patients prescribed SGLT-2 inhibitors within 12 months of a cirrhosis diagnosis were compared with those who were not prescribed SGLT-2 inhibitors.

The investigators then examined three subgroups, namely MASH cirrhosis, alcohol-associated cirrhosis, and “other” cirrhosis. They also performed propensity score matching (PSM) incorporating 47 variables within each subgroup to control for liver disease severity/aetiology.

PSM yielded 10,976 patients with cirrhosis (n=5,488 each in the SGLT-2 inhibitor and control groups), of whom 6,052 had MASH cirrhosis, 2,864 alcohol-related cirrhosis, and 2,060 other cirrhosis. Baseline characteristics did not significantly differ between the two treatment groups after matching.

Patients treated with SGLT-2 inhibitors were less likely to develop new portal hypertensive complications, including ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, and hepatorenal syndrome (MASH: hazard ratio [HR], 0.73, 95 percent confidence interval [CI], 0.64‒0.83; alcohol: HR, 0.58, 95 percent CI, 0.49‒0.68; other: HR, 0.60, 95 percent CI, 0.47‒0.76; p<0.0010 for all).

Ascites were the complications that had the greatest reduction.

Sensitivity analyses of decompensated cirrhosis patients revealed fewer new portal hypertension complications among patients prescribed SGLT-2 inhibitors, who also showed a reduced risk of all-cause mortality (MASH: HR, 0.57, 95 percent CI, 0.49‒0.66; alcohol: HR, 0.65, 95 percent CI, 0.55‒0.77; other: HR, 0.49, 95 percent CI, 0.39‒0.62; p<0.001 for all).