Global 
Deutschland Liver and Bile
Hepatology. 2024;79(6):1401–11
Association of glucagon-like peptide-1 receptor agonists with serious liver events among patients with type 2 diabetes: A Scandinavian cohort study
Background and aims: Clinical trials suggest that glucagon-like peptide-1 receptor agonists (GLP-1RA) may have beneficial effects on non-alcoholic fatty liver disease (NAFLD), but the impact on hard hepatic end points is unknown. The authors assessed the association between the use of GLP-1RA and the risk of serious liver events in routine clinical practice.
Approach and results: Cohort study using data from nationwide registers in Sweden, Denmark, and Norway, 2007–2020, including 91,479 initiators of GLP-1RA and 244,004 initiators of the active comparator, dipeptidyl peptidase-4 (DPP4) inhibitors, without a history of chronic liver disease other than NAFLD/non-alcoholic steatohepatitis (NASH). The primary outcome was serious liver events: a composite of incident compensated and decompensated cirrhosis and hepatocellular carcinoma (HCC). Secondary outcomes were the individual components of the primary outcome. Cox regression was used to estimate hazard ratios (HRs), using propensity score weighting to control for confounding. Users of GLP-1RA had 608 serious liver events (adjusted incidence rate = 16.9 events per 10,000 person-years), compared with 1770 events among users of DPP4 inhibitors (19.2 events per 10,000 person-years). The adjusted HR was 0.85 (95% confidence interval [CI]: 0.75–0.97), and the rate difference was -2.1 (-4.4–0.1) events per 10,000 person-years. In secondary outcome analyses, the adjusted HR was 0.85 (95% CI: 0.75–0.97) for compensated and decompensated cirrhosis and 1.05 (95% CI: 0.80–1.39) for HCC.
Conclusions: The use of glucagon-like peptide-1 receptor agonists was associated with a significantly reduced risk of serious liver events, driven by a reduction of compensated and decompensated cirrhosis.