Sodium‐glucose co‐transporter 2 inhibitors reduce hepatic events in diabetic patients with chronic hepatitis B

Abstract

Background Sodium-glucose co-transporter 2 inhibitors (SGLT2i) are a novel class of anti-diabetic drugs that lower the blood glucose level by inhibiting the renal glucose reabsorption. We aimed to evaluate the effect of SGLT2i on the risk of hepatic events in diabetic patients with chronic hepatitis B (CHB). Methods This is a retrospective territory-wide cohort study. Nucleos(t)ide analogue (NA)-treated diabetic patients with CHB were included. Patients who used SGLT2i for more than 90 days were classified as SGLT2i users and those who had never used SGLT2i were defined as non-SGLT2i users. The primary endpoint was the cumulative incidence of hepatic events. Results Among 5276 NA-treated diabetic patients with CHB, 393 (7.4%) patients were SGLT2i users and 4883 (92.6%) patients were non-users. Ten (2.5%) SGLT2i users and 739 (15.1%) non-users developed hepatic events during the mean follow-up of 25 and 63 months respectively. SGLT2i treatment was significantly associated with a lower risk of hepatic events in univariate analysis (subdistribution hazard ratio (SHR): 0.43, 95% CI: 0.22-0.84, P = 0.013) and log-rank test (P = 0.01) before propensity score (PS) weighting. This association was also observed in Fine-Gray subdistribution hazard regression after PS weighting (weighted SHR: 0.42, 95% CI: 0.19-0.90, P = 0.026). Conclusions Use of SGLT2i may be linked with a lower risk of hepatic events in NA-treated diabetic patients with CHB. Larger cohort studies or randomised trials are warranted.