GLP-1 medications shown to improve liver disease
October 1, 2024
Source: Kanwal, et al JAMA Int Med September 16, 2024. Control group was treated with DPP-4 medications for diabetes.
Metabolic Associated Steatohepatitis (MASH, previously called NASH or nonalcoholic fatty liver disease) is a major cause of cirrhosis (liver failure) and represents the second largest cause of liver transplants. Furthermore, MASH is common and increasing in frequency as obesity rates rise.
Researchers from the Veterans Administration followed over 16,000 patients with diabetes who were treated with GLP-1 medications from 2006 to 2022, and compared their outcomes with a matched group with diabetes who were treated with a different class of medications (DPP-4). They found that those treated with GLP-1s before they had liver damage were statistically significantly less likely to progress to liver failure. They were also 11% less likely to die and 11% less likely to develop liver cancer during the study period. Those treated when cirrhosis was already in place did not have better liver outcomes. The decrease in progression to cirrhosis began about 18 months after GLP-1 medications were initiated.
This study adds to earlier studies that showed decrease in progression to cirrhosis, but those earlier studies had no control group. This report described an observational study, and controls were chosen to have similar risks to those treated with GLP-1 medications. During most of the study period, newer and more effective GLP-1s (semaglutide and tirzepatide) were not available. There is a single oral drug currently approved for treating MASH, resmetirom (Rezdiffra), which has a wholesale acquisition price of $47,700.
Implications for employers:
This study shows that GLP-1 drugs decrease bad outcomes in those with diabetes and liver disease. Studies are ongoing about whether the newer GLP-1 medications will lower risk of liver complications in those with obesity who do not have diabetes.
GLP-1 drugs have now shown multiple benefits for those with diabetes, including decreased cardiovascular disease, decreased progression to renal failure, and now decreased progression to liver failure. This study supports the decisions of most employers to provide GLP-1 coverage for people with diabetes.
Thanks for reading. You can find previous posts in the Employer Coverage archive
Please subscribe, “like” and suggest this newsletter to friends and colleagues. Thanks!
Wednesday: Remote monitoring lowers blood pressure but adoption is low