S2906 Racial Differences in Clinical Outcomes Among Cirrhotic Patients on SGLT2 Inhibitors: A Propensity-Matched Analysis

Introduction: Sodium-glucose co-transporter 2 inhibitors (SGLT2-i) have demonstrated cardio-renal benefits in patients with type 2 diabetes mellitus and are increasingly prescribed in populations with advanced liver disease. However, recent data from meta-analysis of clinical trials suggest clinical outcome discrepancy between Black and White patients. The real-world clinical outcomes of SGLT2-i across racial groups—particularly among patients with cirrhosis—remains to be determined This study aimed to compare clinical outcomes between Black and White patients with cirrhosis on SGLT2-i in a large research database. Methods: Using the TriNetX research network, we identified adult Black and White patients with cirrhosis who were prescribed SGLT2-i. A total of 6,255 Black and 33,215 White patients were identified. After 1:1 propensity score matching based on demographics, liver function, MELD components, and cardiometabolic comorbidities, 6,238 matched pairs were analyzed. Outcomes were assessed over a 3-year follow-up period using time-to-event analysis. The primary outcome was all-cause mortality. Secondary outcomes included all-cause hospitalizations, ascites, spontaneous bacterial peritonitis (SBP), hepatic encephalopathy (HE), and variceal bleeding. Results: Compared to White patients, Black patients with cirrhosis on SGLT2-i experienced significantly lower rates of all-cause mortality (11.9% vs 15.8%; P < 0.001) and all-cause hospitalizations (43.0% vs 46.4%; P < 0.001). Rates of ascites (14.5% vs 19.3%; P < 0.001), SBP (0.9% vs 1.5%; P = 0.005), HE (3.4% vs 6.5%; P < 0.001), and variceal bleeding (0.6% vs 1.2%; P < 0.001) were also significantly lower among Black patients. These findings persisted despite matching for relevant clinical and biochemical covariates. Conclusion: In this large real-world analysis of patients with cirrhosis on SGLT2-i, Black patients demonstrated significantly better outcomes compared to White patients across all measured domains, including mortality, hospitalizations, and decompensated cirrhosis events. In contrast to meta-analysis of clinical trial data, the findings from large real world retrospective studies indicate SGLT2-i is associated with improved liver related outcomes. The discrepancy underscores the need for further investigation into genetic, socioeconomic, and access-related factors contributing to these disparities.