Long‐term metformin use may improve clinical outcomes in diabetic patients with non‐alcoholic steatohepatitis and bridging fibrosis or compensated cirrhosis

Summary Background Metformin may protect against hepatocellular carcinoma and mortality among patients with type 2 diabetes. Aim To investigate whether long‐term use of metformin improves survival and reduces liver‐related outcomes among patients with type 2 diabetes and non‐alcoholic steatohepatiti...

Full description

Saved in:
Bibliographic Details
Published in:Alimentary pharmacology & therapeutics 2019-08, Vol.50 (3), p.317-328
Main Authors: Vilar‐Gomez, Eduardo, Vuppalanchi, Raj, Desai, Archita, Gawrieh, Samer, Ghabril, Marwan, Saxena, Romil, Cummings, Oscar W., Chalasani, Naga
Format: Article
Language:English
Subjects:
Acidosis
Aged
Biopsy
Carcinoma, Hepatocellular - complications
Carcinoma, Hepatocellular - mortality
Cirrhosis
Clinical outcomes
Diabetes
Diabetes mellitus
Diabetes mellitus (non-insulin dependent)
Diabetes Mellitus, Type 2 - complications
Diabetes Mellitus, Type 2 - diagnosis
Diabetes Mellitus, Type 2 - drug therapy
Diabetes Mellitus, Type 2 - mortality
Female
Fibrosis
Follow-Up Studies
Health care facilities
Hepatocellular carcinoma
Hepatotoxicity
Humans
Lactic acidosis
Liver cancer
Liver cirrhosis
Liver Cirrhosis - complications
Liver Cirrhosis - diagnosis
Liver Cirrhosis - drug therapy
Liver Cirrhosis - mortality
Liver Neoplasms - complications
Liver Neoplasms - mortality
Male
Metformin
Metformin - therapeutic use
Middle Aged
Mortality
Non-alcoholic Fatty Liver Disease - complications
Non-alcoholic Fatty Liver Disease - diagnosis
Non-alcoholic Fatty Liver Disease - drug therapy
Non-alcoholic Fatty Liver Disease - mortality
Patients
Prognosis
Retrospective Studies
Survival
Survival Analysis
Time Factors
Treatment Outcome
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Summary Background Metformin may protect against hepatocellular carcinoma and mortality among patients with type 2 diabetes. Aim To investigate whether long‐term use of metformin improves survival and reduces liver‐related outcomes among patients with type 2 diabetes and non‐alcoholic steatohepatitis. Methods A total of 191 diabetic patients with biopsy‐proven non‐alcoholic steatohepatitis and bridging fibrosis or compensated cirrhosis were retrospectively identified at Indiana University Medical Center between October 2004 and January 2016. Of them, 110 were users and 81 never‐users of metformin. Primary outcomes were transplant‐free survival, development of hepatocellular carcinoma or a first event of hepatic decompensation. Results Cirrhosis was present in 85% of metformin users and 88% of nonusers. Metformin dose was greater than or equal to 1 g/d in 104 out of 110 users and its median duration of use was 6 (95% CI: 4.4‐7.9) years. The mean follow‐up was 6.92 and 6.80 years for metformin users and non‐users, respectively. During follow‐up, 28 patients developed hepatocellular carcinoma (metformin users: 7, nonusers: 21), and 52 died (metformin users: 7, nonusers: 24) or were transplanted (metformin users: 13, non‐users: 13). Metformin use was associated with lower risk of overall mortality or transplant (HR: 0.42; 95% CI: 0.24‐0.74, P = 0.003) and hepatocellular carcinoma (sHR: 0.25; 95% CI: 0.11‐0.58, P = 0.001), and remained independently associated with both outcomes after propensity‐score and covariate‐adjusted analyses. No instances of hepatotoxicity or lactic acidosis were observed. Conclusion Our study demonstrated an association between long‐term metformin use and reduced the risk of all‐cause mortality/transplant and hepatocellular carcinoma in diabetics with non‐alcoholic steatohepatitis and advanced fibrosis.
ISSN:0269-2813
1365-2036
DOI:10.1111/apt.15331