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Thiazolidinediones and Glucagon‐Like Peptide‐1 Receptor Agonists and the Risk of Nonalcoholic Fatty Liver Disease: A Cohort Study
Author(s) -
Dalem Judith,
Driessen Johanna H. M.,
Burden Andrea M.,
Stehouwer Coen D. A.,
Klungel Olaf H.,
Vries Frank,
Brouwers Martijn C. G. J.
Publication year - 2021
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.32012
Subject(s) - nonalcoholic fatty liver disease , medicine , glucagon like peptide 1 , cohort , endocrinology , glucagon like peptide 1 receptor , disease , receptor , fatty liver , diabetes mellitus , agonist , type 2 diabetes
Background and Aims Thiazolidinediones (TZDs) and glucagon‐like peptide‐1 (GLP‐1) receptor agonists are potential pharmacological treatment options for patients at risk of NAFLD. Therefore, we examined the association between the risk of NAFLD and the use of TZDs and GLP‐1 receptor agonists compared with the use of sulfonylureas (SUs) and insulins. Additionally, we calculated the incidence of HCC in users of TZDs and GLP‐1 receptor agonists. Approach and Results We conducted a population‐based cohort study using primary care data from the Clinical Practice Research Datalink database (2007‐2018). All patients aged ≥18 with a prescription of an oral glucose‐lowering agent or GLP‐1 receptor agonist were included. The first prescription defined the start of follow‐up. The primary outcome was a new diagnosis of NAFLD. Cox proportional hazards regression was used to estimate HRs and 95% CIs of the primary outcome. Incidence rates of HCC were determined per 1,000 person‐years for all exposures. The study identified 207,367 adults with a prescription for a glucose‐lowering agent. The risk of NAFLD was lower in patients prescribed a TZD than in those prescribed an SU (adjusted HR [aHR], 0.32; 95% CI, 0.20‐0.51). No difference in risk of NAFLD was observed comparing GLP‐1 receptor agonist use with insulin use (aHR, 1.22; 95% CI, 0.91‐1.63). Conclusions Results of our study endorse the use of TZDs for selected patients at risk of NAFLD but do not support previous findings regarding the beneficial effect of GLP‐1 receptor agonists. The low number of events in several subgroups may affect the generalizability of the current findings.