SGLT2 Inhibitors Linked to Lower Fibrosis Progression than DPP‑4 Inhibitors in MASLD with T2DM: Target‑Trial Emulation of Real‑World Cohorts

Highlights

– In a propensity score–matched target‑trial emulation of 2,571 matched pairs, SGLT2 inhibitor (SGLT2i) use was associated with a lower rate of progression to advanced fibrosis compared with dipeptidyl peptidase‑4 inhibitor (DPP‑4i) use (HR 0.78; 95% CI 0.67–0.89).
– Absolute rates of confirmed fibrosis progression were 3.46 versus 4.44 events per 100 person‑years for SGLT2i versus DPP‑4i users; median follow‑up was 3.7 years.
– No difference in major adverse liver outcomes (MALO: incident cirrhosis, decompensation, hepatocellular carcinoma, liver transplant) was observed, likely reflecting low event rates and limited follow‑up for hard outcomes.

Background and disease burden