S2792 SGLT2 Inhibitors and Clinical Outcomes in Patients With Primary Biliary Cholangitis and Type 2 Diabetes: A Global Cohort Study

Introduction: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are widely used in diabetes management, demonstrating cardiovascular and renal benefits. Emerging evidence has revealed potential benefit in liver-related outcome in metabolic dysfunction associated steatotic liver disease (MASLD) and cirrhosis. However, its impact on liver related outcomes in primary biliary cholangitis (PBC) populations with diabetes mellitus remains to be determined. This study evaluated clinical outcomes associated with SGLT2i use in patients with PBC and type 2 diabetes mellitus (T2DM) in a large research database. Methods: A retrospective cohort analysis using TriNetX data was conducted. Patients diagnosed with PBC and T2DM were stratified into those receiving SGLT2i (n = 1,198) and those not receiving SGLT2i (n = 1,198), matched using propensity scoring for demographics, comorbidities, medications, and labs. Outcomes assessed over 12 months included ascites, jaundice, hepatic encephalopathy (HE), hepatocellular carcinoma (HCC), mortality (ACM), and hospitalizations (ACH). Outcomes were reported as risk ratios (RR) with 95% confidence intervals (CIs). Results: Patients on SGLT2i were associated with significantly reduced risks of developing ascites (RR = 0.62, 95% CI: 0.51–0.76), jaundice (RR = 0.61, 95% CI: 0.38–0.98), all-cause mortality (RR = 0.60, 95% CI: 0.45–0.81), and hospitalizations (RR = 0.79, 95% CI: 0.69–0.91). No significant associations were observed for hepatic encephalopathy (RR = 0.80, 95% CI: 0.58–1.10), hepatocellular carcinoma (RR = 0.84, 95% CI: 0.53–1.34), and variceal bleeding (RR = 0.64, 95% CI: 0.33–1.24). Conclusion: In this matched cohort analysis, SGLT2 inhibitor use in patients with PBC and T2DM was associated with significantly lower risks of ascites, jaundice, mortality, and hospitalizations. Prospective studies are warranted to further analyze these findings and explore underlying mechanisms.