ArticleHepatology international2026
Tirzepatide versus SGLT2 inhibitors for MASLD: a multi-institutional propensity score-matched cohort study.
Article in Hepatology international, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundTirzepatide (TZP) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) have both shown promise in managing metabolic dysfunction-associated steatotic liver disease (MASLD). However, direct comparative data are limited. This study aimed to evaluate the real-world effectiveness of TZP versus SGLT2i in adults with MASLD.
methodsWe conducted a retrospective, multi-institutional cohort study using the TriNetX global research network. Adults (≥ 18 years) with a diagnosis of MASLD who were newly initiated on TZP or SGLT2i between January 1, 2022, and June 30, 2025, were included. The primary outcome was a composite of all-cause mortality, major adverse cardiovascular events (MACEs), and major adverse liver outcomes (MALOs). Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).
resultsAfter 1:1 propensity score matching, 23,106 patients were included in each group. Compared to SGLT2i, TZP use was associated with a significantly lower risk of the primary composite outcome (HR, 0.72; 95% CI, 0.63-0.83). TZP was also associated with lower risks of all-cause mortality (HR, 0.55; 95% CI, 0.43-0.71), MACEs (HR, 0.68; 95% CI, 0.58-0.80), and MALOs (HR, 0.66; 95% CI, 0.54-0.80). These associations were consistent across subgroups stratified by age, sex, BMI, and comorbidities.
conclusionsIn this large real-world study, TZP was associated with significantly better clinical outcomes than SGLT2i in adults with MASLD. These findings support TZP as a preferred treatment option and highlight the need for prospective trials to validate these results.
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