VA Innovation in Liver Disease

The VA continues to innovate in healthcare generally and liver disease specifically.

Including with GLP-1s–

“GLP1-RA reduces risk of death in liver disease patients

Researchers from VA Orlando and the University of Florida reported Veterans with non-alcoholic liver disease who were prescribed GLP1-RA, a newer medication used to treat diabetes and obesity, had less liver disease progression and were 28% less likely to die of heart attacks than patients prescribed another common diabetes medication, DPP4i.

The researchers examined the medical records of nearly 120,000 Veterans with the common liver disease metabolic dysfunction-associated steatotic liver disease (MASLD) between 2005 and 2021. MASLD can lead to liver cirrhosis and is associated with an increased risk of major acute cardiovascular events such as heart attack and stroke. The first line of treatment for MASLD is weight loss, and GLP1-RA is increasingly used to help with weight loss. The findings indicate GLP1-RA can lower the risk of both liver disease progression and heart attack, and may be more effective than prioritizing treating liver disease on its own. View the full study from ‘Diabetes, Obesity and Metabolism.‘”

The analysis pooled data from the SURPASS 1–5 phase 3 clinical trials of tirzepatide (a dual GIP/GLP-1 receptor agonist) in patients with type 2 diabetes.

The composite endpoints assessed included: achieving HbA1c targets (e.g., <7.0%, ≤6.5%, or <5.7%), achieving weight-loss thresholds (≥5%, ≥10%, ≥15%), and without experiencing hypoglycaemia.

Key results:

• A substantial proportion of people treated with tirzepatide achieved the composite targets compared to comparators (placebo, basal insulin, or ­GLP-1 monotherapy) across the SURPASS trials.
• For example, achieving HbA1c <7.0 % + ≥5% weight loss + no hypoglycaemia ranged from ~43% to ~82% in tirzepatide groups vs ~4-5% with placebo, ~51% with semaglutide 1 mg, ~5% with basal insulin.
• The findings held for more stringent targets of weight loss (≥10%, ≥15%) and stricter HbA1c thresholds.

The authors conclude that in people with type 2 diabetes, tirzepatide enabled more participants to reach meaningful composite endpoints of glycaemic control + weight loss + no hypoglycaemia than the comparators.