ArticleFrontiers in pharmacology2026
Comparative effectiveness of tirzepatide versus thiazolidinedione in adults with MASLD: a propensity score-matched cohort study.
Article in Frontiers in pharmacology, 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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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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8 authors.
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Abstract
Background: Tirzepatide (TZP) and thiazolidinediones (TZDs) have both shown promise in treating metabolic dysfunction-associated steatotic liver disease (MASLD), yet direct comparative evidence remains scarce. This real-world study aimed to compare the clinical effectiveness of TZP and TZDs in adults diagnosed with MASLD. Methods: We conducted a retrospective, multi-institutional cohort study using data from the TriNetX global health research network. Adults with MASLD who were newly initiated on TZP or TZD were included. The primary outcome was a composite measure encompassing all-cause mortality, major adverse liver outcome (MALO), major adverse cardiovascular event (MACE), and major adverse kidney event (MAKE). Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards models. Results: After 1:1 propensity score matching, each treatment arm included 9,262 patients. TZP use was significantly associated with a reduced risk of the composite primary outcome compared to TZD (HR, 0.66; 95% CI, 0.58-0.42). Additionally, TZP was linked to lower risks of all-cause mortality (HR, 0.48; 95% CI, 0.32-0.71), MALO (HR, 0.50; 95% CI, 0.36-0.69), MACE (HR, 0.65; 95% CI, 0.51-0.82), and MAKE (HR, 0.50; 95% CI, 0.36-0.69). These associations were consistent across subgroups stratified by age, sex, body mass index, and underlying comorbidities. Conclusion: In this large real-world cohort study, TZP was associated with lower risks of all-cause mortality, MALO, MACE, and MAKE compared to TZDs in adults with MASLD. While these findings suggest a potential clinical advantage, the observational design precludes causal inference. Prospective randomized trials are needed to confirm these associations and establish evidence-based treatment recommendations.
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