Endocrinology, diabetes & metabolism · 2025
Comparative Effectiveness of Bariatric Surgery Versus GLP-1 Receptor Agonists in Reducing the Risk of New-Onset of NASH: A Retrospective Multinational Cohort Study From North America and Europe.
СтатьяСравнительное исследованиеМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Hussein Abdallah, Awashra Ameer, Rajab Islam, Bdair Mohammad, Hamdan Dawoud, Nouri Ahmad, Khatib Elaf, Khatib Ghiras, Latt Nyan
Аннотация
BACKGROUND: Nonalcoholic steatohepatitis (NASH) is a severe form of nonalcoholic fatty liver disease (NAFLD) that can progress to cirrhosis and hepatocellular carcinoma (HCC). Obesity is a major risk factor for NASH, and metabolic interventions such as bariatric surgery (BS) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have been explored for their impact on liver-related outcomes. This study evaluates the comparative effectiveness of BS and GLP-1 RAs in reducing the incidence of new-onset NASH and related hepatic complications.
METHODS: This was a large, population-based, retrospective cohort using data from the TriNetX platform. Adult patients with a body mass index (BMI, of 35 or greater and without a history of NAFLD/NASH (without cirrhosis) who underwent BS versus GLP-1RA between January 1, 2014 and December 31, 2019, were included. Patients in the BS group were matched with patients in the GLP-1RA group according to age, demographics, comorbidities and medication by using 1:1 propensity matching.
RESULTS: Among 180,022 eligible adults, 143,404 underwent BS, while 36,618 received GLP-1 RA therapy. Following propensity score matching, 33,594 patients in the BS group (mean age 49.1 ± 13.2 years; 72.73% female) were matched to an equal number of individuals in the GLP-1 RA group (mean age 48.9 ± 14.0 years; 72.41% female). Compared to those receiving GLP-1 RA therapy, patients who underwent BS had a significantly lower risk of HCC (HR, 0.304; 95% CI, 0.099-0.931), which showed the strongest protective effect, followed by a substantial reduction in NASH (HR, 0.509; 95% CI, 0.469-0.551). The reduction in liver cirrhosis risk was not statistically significant (HR, 0.865; 95% CI, 0.696-1.075). These associations remained across follow-up periods of 1, 3, 5 and 7 years.
CONCLUSIONS: These findings suggest that BS was significantly associated with lower risk of new onset of NASH/NAFLD.
METHODS: This was a large, population-based, retrospective cohort using data from the TriNetX platform. Adult patients with a body mass index (BMI, of 35 or greater and without a history of NAFLD/NASH (without cirrhosis) who underwent BS versus GLP-1RA between January 1, 2014 and December 31, 2019, were included. Patients in the BS group were matched with patients in the GLP-1RA group according to age, demographics, comorbidities and medication by using 1:1 propensity matching.
RESULTS: Among 180,022 eligible adults, 143,404 underwent BS, while 36,618 received GLP-1 RA therapy. Following propensity score matching, 33,594 patients in the BS group (mean age 49.1 ± 13.2 years; 72.73% female) were matched to an equal number of individuals in the GLP-1 RA group (mean age 48.9 ± 14.0 years; 72.41% female). Compared to those receiving GLP-1 RA therapy, patients who underwent BS had a significantly lower risk of HCC (HR, 0.304; 95% CI, 0.099-0.931), which showed the strongest protective effect, followed by a substantial reduction in NASH (HR, 0.509; 95% CI, 0.469-0.551). The reduction in liver cirrhosis risk was not statistically significant (HR, 0.865; 95% CI, 0.696-1.075). These associations remained across follow-up periods of 1, 3, 5 and 7 years.
CONCLUSIONS: These findings suggest that BS was significantly associated with lower risk of new onset of NASH/NAFLD.