Liver-related long-term outcomes of thiazolidinedione use in persons with type 2 diabetes

Background & Aims: Studies have described prominent histologic improvement in patients with nonalcoholic steatohepatitis (NASH) using thiazolidinedione (TZD); however, these were all short term with moderate sample size, no liver-related long-term outcomes could be noted. Methods: This retrospective cohort study enrolled patients with newly diagnosed type 2 diabetes mellitus (T2DM) from Taiwan's National Health Insurance Research Database between 1 January 2000 and 31 December 2013. We matched TZD users and nonusers at a 1:1 ratio through propensity score matching. This study included 5095 paired TZD users and nonusers. Cox proportional hazard models were used to compare the risks of cirrhosis, hepatic decompensation, hepatic failure and all-cause mortality between TZD users and nonusers. The Kaplan-Meier method was used to compare the cumulative incidence of these main outcomes. Results: The incidence rates of cirrhosis, hepatic decompensation, hepatic failure and all-cause mortality during follow-up were 0.77 vs 1.95, 1.43 vs 1.75, 0.36 vs 0.70, and 4.89 vs 3.78 per 1000 person-years between TZD users and nonusers. The adjusted hazard ratios of cirrhosis, hepatic decompensation, hepatic failure and all-cause mortality were 0.39 (95% confidence interval [CI]: 0.21-0.72), 0.86 (95% CI: 0.52-1.44), 0.46 (95% CI: 0.18-1.17) and 1.18 (95% CI: 0.87-1.61) respectively. Conclusions: Our study demonstrated that TZD use could significantly lower the risk of cirrhosis. In clinical settings, TZD use might be able to improve liver-related long-term outcomes.