P1147 - Use of Sodium-Glucose Transport Protein 2 Inhibitors and Dipeptidyl Peptidase 4 Inhibitors in Patients with MASLD in a Real-World Setting is Associated with Lower All-Cause Mortality

Sophia Hurr, BSPH¹, Breda Munoz, PhD², Andrea Rossi. Mospan, PhD, RAC², Michael Roden, MD³, Kenneth Cusi, MD⁴, Alfred S. Barritt, MD, MSCR^5
1University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC; ²Target RWE, Durham, NC; ³Heinrich Heine University, Dusseldorf, Nordrhein-Westfalen, Germany; ⁴University of Florida College of Medicine, Gainesville, FL; ⁵UNC, Chapel Hill, NC

Introduction: While there has been an increasing focus on using glucagon-like peptide 1 receptor agonists for the treatment of metabolic dysfunction associated steatotic liver disease (MASLD), other glucose lowering drugs like sodium-glucose transport protein 2 inhibitors (SGLT2) and dipeptidyl peptidase 4 inhibitors (DPP4) have been less studied in liver disease. This analysis aims to describe patient characteristics and outcomes in patients with MASLD who use SGLT2 or DPP4 medications.

Methods: Adults included in the study were enrolled from 2016-2023 in the TARGET-NASH US cohort with >1 year of follow up without liver transplant or liver cancer. Minimum SGLT2 and DPP4 use was >1 year. Demographic and clinical features were described among users and non-users. The primary outcome was all-cause mortality. Baseline characteristics are reported as well as Cox proportional hazard ratios.

Results: There were 3712 adult patients from the TARGET-NASH US cohort who met inclusion criteria. Overall, 105 (3%) used SGLT2 medications and 104 (3%) used DPP4 medications. There were no differences in age, sex, insurance type among SGLT2 users and non-users. Compared to non-users, SGLT2 users were more likely Caucasian (84% vs 67%, p=0.006), had higher BMI (34 vs 32 kg/m² p=0.007), seen at an academic site (78% vs 58% p< 0.001), enrolled by endocrinologists (16% vs 2% p< 0.001), and had higher prevalence of cardiovascular disease, hypertension, dyslipidemia, and diabetes (all p< 0.05). Among SGLT2 users, 24 (23%) had MASL, 12 (11%) MASH and 69 (66%) cirrhosis. Compared to non-users, DPP4 users were older (65 vs 58 years, p< 0.001) Caucasian (80% vs 67%, p=0.04), insured by Medicare (45% vs 28%, p=0.004), seen at an academic site (70% vs 59% p=0.018), enrolled by endocrinologists (9% vs 3% p=0.007), and had higher prevalence of cardiovascular disease, hypertension, dyslipidemia, and diabetes (all p< 0.05). Among DPP4 users, 15 (14%) had MASL, 15 (14%) MASH and 74 (72%) cirrhosis. The HR for overall mortality in SGLT2 non-users vs users was 2.57 (95% CI 1.13, 5.82). The HR for overall mortality in DPP4 non-users vs users was 2.22 (95% CI 1.08, 4.53).

Discussion: SGLT2 and DPP4 users were more likely to be enrolled from academic and endocrinology practices and had better overall survival than non-users in this real-world setting. Further research into effectiveness of these medications in patients with MASLD and broader application by gastroenterologists/hepatologists is warranted.


Disclosures:


Sophia Hurr, BSPH¹, Breda Munoz, PhD², Andrea Rossi. Mospan, PhD, RAC², Michael Roden, MD³, Kenneth Cusi, MD⁴, Alfred S. Barritt, MD, MSCR⁵. P1147 - Use of Sodium-Glucose Transport Protein 2 Inhibitors and Dipeptidyl Peptidase 4 Inhibitors in Patients with MASLD in a Real-World Setting is Associated with Lower All-Cause Mortality, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.