{
  "abstract": "Introduction Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease (NAFLD), commonly co-occurs with type 2 diabetes mellitus (T2DM) and increases risks of cardiometabolic and hepatic complications. Sodium-glucose cotransporter-2 inhibitors (SGLT2is) and dipeptidyl peptidase-4 inhibitors (DPP4is) are commonly prescribed antidiabetic agents with potential hepatic benefits, yet large-scale, real-world head-to-head comparisons in patients with MASLD are limited.Methods This multicenter, retrospective cohort study utilized de-identified electronic health records from the TriNetX U.S. Collaborative Network. Adults (≥18 years) with MASLD, and at least one metabolic comorbidity (T2DM, obesity, dyslipidemia, metabolic syndrome, or hypertension) were included. Patients newly initiating SGLT2is (n=111,357; e.g., empagliflozin, dapagliflozin, canagliflozin) or DPP4is (n=43,868; e.g., sitagliptin, linagliptin) without cross-exposure were identified. One-to-one propensity score matching (caliper 0.1 SD) balanced cohorts at 41,793 patients each, using >50 covariates (demographics, comorbidities, medications, laboratories, vitals). Time-to-event analyses for all-cause mortality, all-cause hospitalization, major adverse cardiovascular events (MACE), major adverse liver outcomes (MALO), major adverse kidney events (MAKE), ascites, hepatic failure, and hepatic encephalopathy were performed at 1-year and 3-year follow-up using Cox proportional hazards models.Results In propensity-matched cohorts, SGLT2is were associated with significantly lower risks compared to DPP4is for: All-cause mortality (1-year HR 0.746, 95% CI 0.674–0.825; 3-year HR 0.778, 95% CI 0.725–0.834); MAKE (1-year HR 0.316, 95% CI 0.281–0.355; 3-year HR 0.419, 95% CI 0.383–0.459); MALO (1-year HR 0.837, 95% CI 0.742–0.944; 3-year HR 0.856, 95% CI 0.780–0.940); Ascites (1-year HR 0.761, 95% CI 0.660–0.879; 3-year HR 0.823, 95% CI 0.738–0.919). All-cause hospitalization showed modest benefit at 1 year (HR 0.951, 95% CI 0.921–0.982) but neutrality at 3 years (HR 1.011, 95% CI 0.984–1.039). Conversely, MACE risk was higher with SGLT2is (1-year HR 1.225, 95% CI 1.158–1.295; 3-year HR 1.171, 95% CI 1.119–1.226). No significant differences emerged for hepatic failure or hepatic encephalopathy.Conclusions In this large, multicenter, propensity score-matched real-world cohort of patients with MASLD, initiation of SGLT2is conferred superior protection against all-cause mortality, major kidney events, major liver events, and ascites compared with DPP4is, with the strongest benefits observed in renal outcomes. While hospitalization benefits were short-term and MACE rates were modestly higher with SGLT2is, these findings support preferential consideration of SGLT2is in MASLD patients requiring antidiabetic therapy.Abstract FP25 Figure 1",
  "authors": [
    {
      "affiliations": [
        "Frimley Health NHS Foundation Trust, Frimley, United Kingdom"
      ],
      "name": "Usman Saleem"
    },
    {
      "affiliations": [
        "Dhaka Medical College and Hospital, Dhaka, Bangladesh"
      ],
      "name": "Ibrahim Khalil"
    },
    {
      "affiliations": [
        "Manikganj Medical College and Hospital, Manikganj, Bangladesh"
      ],
      "name": "Md Imran Hossain"
    },
    {
      "affiliations": [
        "Chattogram Medical College, Bangladesh"
      ],
      "name": "Md Rafid Bhuiyan Aiman"
    },
    {
      "affiliations": [
        "Manikganj Medical College and Hospital, Manikganj, Bangladesh"
      ],
      "name": "Mst Mahmuda Akter"
    },
    {
      "affiliations": [
        "Shaheed Suhrawardy Medical College, Dhaka, Bangladesh"
      ],
      "name": "Nabila Nur"
    },
    {
      "affiliations": [
        "Peshawar Medical College, Pakistan"
      ],
      "name": "Aizaz Anwar Khalid"
    },
    {
      "affiliations": [
        "College of Medicine, University of Warith Al-Anbiyaa, Karbala, Iraq"
      ],
      "name": "Sajjad Ghanim Al-Badri"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Reading Hospital, West Reading, United State of America"
      ],
      "name": "Pallab Sarker"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Flushing Hospital Medical Center, New York, United State of America"
      ],
      "name": "Mohd Turzo Rahman"
    },
    {
      "affiliations": [
        "Frimley Health NHS Foundation Trust, Frimley, United Kingdom"
      ],
      "name": "Raja Mobeen Ahmed"
    },
    {
      "affiliations": [
        "Lahore General Hospital, Lahore, Pakistan"
      ],
      "name": "Hadaiqa Sahar Fatima"
    },
    {
      "affiliations": [
        "Manchester University Foundation Trust, Manchester, United Kingdom"
      ],
      "name": "Adeel Hamad"
    },
    {
      "affiliations": [
        "Frimley Health NHS Foundation Trust, Frimley, United Kingdom"
      ],
      "name": "Kuldeep Cheent"
    }
  ],
  "title": "FP25 Efficacy of SGLT2 inhibitors versus DPP4 inhibitors in metabolic dysfunction-associated steatotic liver disease (MASLD): a multicenter propensity-matched real-world study",
  "uid": "eb0b4e7c-748f-587d-ba7f-2049ae99bd71"
}