Evidence mapPaperPMID 42584814Full record

ArticleHepatology international2026

Comparative risk of hepatocellular carcinoma and mortality among initiators of GLP-1 receptor agonists versus other glucose-lowering therapies: a target trial emulation.

Jesus Gibran Hernández-Pérez, Omer Abdelgadir, Subin Jang, Deepali K Ernest, Xiaotao Zhang, Dimpy Shah, Arthur S Hong, Jaime P Almandoz, Lindsay G Cowell, Sarah E Messiah and 1 more

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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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0citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Jesus Gibran Hernández-PérezPeter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA. JesusGibran.HernandezPerez@UTSouthwestern.edu.ORCID http://orcid.org/0000-0002-7637-4127
Omer AbdelgadirPeter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
Subin JangPeter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
Deepali K ErnestPeter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
Xiaotao ZhangDivision of Liver Disease, Department of Medicine & Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Dimpy ShahCancer Prevention and Control, Houston Methodist Neal Cancer Center, Houston, TX, USA.
Arthur S HongDepartment of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Jaime P AlmandozDepartment of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Lindsay G CowellPeter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
Sarah E MessiahPeter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
David S LopezPeter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.

Funding

UT Southwestern Center for Translational MedicineUL1TR003163 · UT SOUTHWESTERN MEDICAL CENTER · 2025 to 2025
$7.5M
UT Southwestern Medical Center Simmons Comprehensive Cancer CenterP30CA142543 · UT SOUTHWESTERN MEDICAL CENTER · 2025 to 2025
$4.4M
UT Southwestern NORCP30DK127984 · UT SOUTHWESTERN MEDICAL CENTER · 2025 to 2025
$1.2M
Cancer Prevention and Research Institute of Texas RP210130NCATS NIH HHS UL1TR003163NCI NIH HHS P30CA142543NIDDK NIH HHS P30DK127984Patient-Centered Outcomes Research Institute RI-MISSOURI-01-PS8
6 · The paper itself

Abstract

introductionGlucagon-like peptide-1 receptor agonists (GLP-1 RA) may influence pathways involved in hepatocarcinogenesis, but evidence regarding their association with hepatocellular carcinoma (HCC) and mortality risk remains heterogeneous. We evaluated the association between GLP-1 RA initiation and HCC incidence compared with commonly used glucose-lowering medications, with secondary exploratory analyses of all-cause mortality following HCC diagnosis.

methodsWe emulated active-comparator, new-user target trials using Patient-Centered Clinical Research Network data from UT Southwestern Medical Center (PCORnet-UTSW; 2010-2025). Adults with T2D initiating GLP-1 RA were compared with initiators of metformin, insulin, sodium-glucose cotransporter-2 inhibitors (SGLT2i), dipeptidyl peptidase-4 inhibitors (DPP4i), and sulfonylureas. The primary outcome was incident HCC; a secondary analysis evaluated all-cause mortality after HCC diagnosis. Five-year risks and risk differences under the intention-to-treat (ITT) approach were estimated using pooled logistic regression with inverse probability of treatment weighting. Per-protocol analyses accounted for treatment adherence using inverse probability of censoring weights.

resultsGLP-1 RA initiators had lower five-year HCC risk than comparator groups. Under ITT, risk differences were - 0.37% (95% CI - 0.59 to - 0.08) versus metformin, - 0.52% (95% CI - 0.74 to - 0.35) versus insulin, - 0.37% (95% CI - 0.70 to - 0.06) versus DPP4i, and - 0.39% (95% CI - 0.64 to - 0.13) versus sulfonylureas. Findings were stronger in per-protocol analyses and consistent across subgroups, sensitivity analyses and by individual GLP-1 RA agent. Mortality analyses were limited by small sample sizes but suggested a potential survival benefit.

conclusionsGLP-1 RA initiation was associated with lower HCC risk versus several comparators. Mortality findings were inconclusive and exploratory, warranting confirmation in larger studies.

Indexed as

Active-comparatorGLP-1 receptor agonistsHepatocellular carcinomaMortalityNew-user designPharmacoepidemiologyReal-world dataTarget trial emulationType 2 diabetes

Identifiers

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.