Abstract
S2596 Long-Term Hepatic and Systemic Outcomes Associated With SGLT2 Inhibitor Therapy in Patients With Obesity and MASLD: A Propensity-Matched Cohort Study
The American journal of gastroenterology, Vol.121(10S1), pp.S566-S566
10/01/2026
DOI: 10.14309/01.ajg.0001219636.72775.a6
Abstract
Introduction:
Metabolic dysfunction–associated steatotic liver disease (MASLD) is closely linked to obesity, insulin resistance, cardiovascular disease, and progressive hepatic fibrosis. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have demonstrated favorable metabolic and cardiometabolic effects and are increasingly studied as potential therapies for MASLD. However, unlike many prior studies that examined SGLT2i use in MASLD alone or broadly among patients with type 2 diabetes, data specifically evaluating patients with coexisting obesity and MASLD remain limited. Furthermore, previous studies have largely focused on metabolic efficacy and surrogate hepatic markers rather than long-term clinical outcomes. We aimed to compare hepatic and systemic outcomes in patients with obesity/MASLD receiving SGLT2i versus those not treated with SGLT2i.
Methods:
We performed a retrospective multicenter cohort study using a large electronic health records database. Adults with obesity and MASLD were stratified by SGLT2i use. After 1:1 propensity score matching, 108,162 patients were included in each cohort. Outcomes over 10 years included mortality, myocardial infarction/cerebrovascular accident (MI/CVA), intrahepatic malignancy, liver cirrhosis, liver fibrosis, liver transplantation, pancreatitis, hospital admissions/emergency department visits, and acute kidney failure. Hazard ratios (HR) with 95% confidence intervals (CI) were calculated.
Results:
After matching, 108,162 patients were included in each cohort. Mean follow-up was 1,164 days in the no-SGLT2i cohort and 1,007 days in the SGLT2i cohort. Compared with SGLT2i users, patients not receiving SGLT2i had higher hazards of mortality (HR 1.58, 95% CI 1.53–1.63), intrahepatic malignancy (HR 1.09, 95% CI 0.99–1.19), liver cirrhosis (HR 1.12, 95% CI 1.08–1.17), liver fibrosis (HR 1.04, 95% CI 0.99–1.09), liver transplantation (HR 1.29, 95% CI 1.04–1.50), hospital admissions/ED visits (HR 1.11, 95% CI 1.08–1.14), and acute kidney failure (HR 1.04, 95% CI 1.01–1.07). MI/CVA (HR 0.90, 95% CI 0.88–0.94) and pancreatitis (HR 1.01, 95% CI 0.94–1.08) were similar between groups.
Conclusion:
In this large propensity-matched cohort of patients with obesity and MASLD, SGLT2i therapy was associated with lower risks of mortality, progressive liver disease, hepatic malignancy, healthcare utilization, and acute kidney injury compared with no SGLT2i use. These findings support a potential protective role of SGLT2 inhibition in metabolic liver disease. Prospective randomized trials are needed to confirm causality.
Details
- Title: Subtitle
- S2596 Long-Term Hepatic and Systemic Outcomes Associated With SGLT2 Inhibitor Therapy in Patients With Obesity and MASLD: A Propensity-Matched Cohort Study
- Creators
- M. Housam NanahMohamad Mahdi OsmanHussam KawasAmr FarwatiOmar T SimsDian J Chiang
- Resource Type
- Abstract
- Publication Details
- The American journal of gastroenterology, Vol.121(10S1), pp.S566-S566
- DOI
- 10.14309/01.ajg.0001219636.72775.a6
- ISSN
- 1572-0241
- eISSN
- 1572-0241
- Publisher
- Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
- Language
- English
- Date published
- 10/01/2026
- Academic Unit
- Internal Medicine
- Record Identifier
- 9985242767802771
Metrics
2 Record Views