Background & Aims: Studies have described prominent histologic improvement in patients with nonalcoholic steatohepatitis (NASH) using thiazolidinedione (TZD); however, these were all short term with moderate sample size, no liver-related long-term outcomes could be noted.Methods: This retrospective cohort study enrolled patients with newly diagnosed type 2 diabetes mellitus (T2DM) from Taiwan's National Health Insurance Research Database between 1 January 2000 and 31 December 2013. We matched TZD users and nonusers at a 1:1 ratio through propensity score matching. This study included 5095 paired TZD users and nonusers. Cox proportional hazard models were used to compare the risks of cirrhosis, hepatic decompensation, hepatic failure and all-cause mortality between TZD users and nonusers. The Kaplan-Meier method was used to compare the cumulative incidence of these main outcomes.
Results: The incidence rates of cirrhosis, hepatic decompensation, hepatic failure and all-cause mortality during follow-up were 0.77 vs 1.95, 1.43 vs 1.75, 0.36 vs 0.70, and 4.89 vs 3.78 per 1000 person-years between TZD users and nonusers. The adjusted hazard ratios of cirrhosis, hepatic decompensation, hepatic failure and Trial Consortium for Stroke, Grant/Award Number: MOST 107-2321-B-039-044; Tseng-Lien Lin Foundation; Katsuzo and Kiyo Aoshima Memorial Funds Handling Editor: Luca Valentiall-cause mortality were 0.39 (95% confidence interval [CI]: 0.21-0.72), 0.86 (95% CI: 0.52-1.44), 0.46 (95% CI: 0.18-1.17) and 1.18 (95% CI: 0.87-1.61) respectively.
Conclusions:Our study demonstrated that TZD use could significantly lower the risk of cirrhosis. In clinical settings, TZD use might be able to improve liver-related long-term outcomes.
K E Y W O R D Snonalcoholic fatty liver disease, cirrhosis, hepatic decompensation, hepatic failure, all-cause mortality, liver-related death
Key pointsThe prevalence of T2DM and NAFLD has dramatically increased worldwide. Our study disclosed that TZD use could significantly lower the risk of cirrhosis as compared with no use. TZD use in patients with T2DM might improve their liver-related long-term outcomes. S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section. How to cite this article: Yen F-S, Yang Y-C, Hwu C-M, et al. Liver-related long-term outcomes of thiazolidinedione use in persons with type 2 diabetes. Liver Int.