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A research team led by Prof. Ju-Young Shin from the School of Pharmacy conducted a large-scale, population-based cohort study utilizing national health claims data to evaluate the effectiveness of sodium-glucose cotransporter 2 (SGLT2) inhibitors in preventing major hepatic events in patients with metabolic dysfunction-associated steatotic liver disease (MASLD).

MASLD is an increasingly prevalent condition worldwide, with a particularly high prevalence of up to 60% among individuals with type 2 diabetes. Given that MASLD remains asymptomatic until it progresses to severe stages and that a multidisciplinary approach is crucial for delaying disease progression, there is an urgent need to explore effective antihyperglycemic therapies that can prevent major hepatic events, including decompensated cirrhosis, ascites, varices, liver failure, and liver transplantation, in patients with MASLD and concomitant type 2 diabetes.

To address this need, Professor Shin’s team conducted a cohort study using the National Health Insurance Service (NHIS) claims database, including patients diagnosed with MASLD who were newly prescribed SGLT2 inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1RAs), or thiazolidinediones (TZDs) between 2014 and 2022. The study compared the risk of major hepatic events across these treatment groups. The findings revealed no significant difference in hepatic event prevention between SGLT2 inhibitors and GLP-1RAs. 

However, compared to TZDs, SGLT2 inhibitors were associated with a 23% reduction in the risk of major hepatic events.

Professor Shin emphasized, “Considering the close relationship between type 2 diabetes and MASLD, current clinical guidelines lack sufficient evidence to support a specific antihyperglycemic therapy for the prevention of major hepatic events in MASLD patients. This study is significant in that it directly compares the hepatic risks associated with SGLT2 inhibitors, GLP-1RAs, and TZDs, thereby generating critical evidence for clinical decision-making.”

This research was supported by a grant from the Patient-Centered Clinical Research Coordinating Center (PACEN) funded by the Ministry of Health & Welfare, Republic of Korea. The study was conducted in collaboration with Professors Jae Hyun Bae and Young Min Cho from the Seoul National University Hospital, Professors Yoosoo Chang and Seungho Ryu from the Kangbuk Samsung Hospital, and Professor Christopher Byrne from the University of Southampton, UK. The findings were officially published in ‘Gut (Impact Factor=23.0, JCR rangking 2.4%)’ on January 17.

※ Title: Risk of hepatic events associated with use of sodium-glucose cotransporter-2 inhibitors versus glucagon-like peptide-1 receptor agonists, and thiazolidinediones among patients with metabolic dysfunction-associated steatotic liver disease

※ Journal: Gut(IF: 23.0)

※ Authors:Professor Ju-Young Shin, Dr. Sungho Bea, Miss. Hwa Yeon Ko

Figure 1. The risk of hepatic decompensation events

Figure 2. Cumulative incidence of hepatic decompensation events