At the American Association for the Study of Liver Diseases (AASLD) 2025 meeting, new real-world data suggest that SGLT2 inhibitors may offer protective benefits for patients with cirrhosis receiving diuretic therapy.
In a study published in JAMA Network Open, Dr. Dian J. Chiang, MD, MPH, section head of Hepatology at Cleveland Clinic, and colleagues analyzed outcomes from 10,660 propensity-matched adults with cirrhosis on furosemide and spironolactone between 2013 and 2021. Half of the cohort also received an SGLT2 inhibitor. Patients were followed for three years.
The addition of SGLT2 inhibitors was associated with a 32% reduction in serious hepatic events—including ascites, varices, hyponatremia, and all-cause mortality—compared with diuretics alone (HR 0.68; 95% CI, 0.66-0.71; P < .001).
Secondary outcomes also showed favorable effects:
- Hepatorenal syndrome: HR 0.47
- Spontaneous bacterial peritonitis: HR 0.55
- Paracentesis: HR 0.54
- Variceal bleeding: HR 0.79
- Hypoglycemia: HR 0.75
- All-cause hospitalizations: HR 0.67
With over 10,000 patients studied, the results hint at a promising new avenue for cirrhosis management, particularly in those with diabetes or heart failure. Still, prospective studies are required before SGLT2 inhibitors can be integrated into routine hepatology practice.
