Clinical outcomes with metformin use in diabetic patients with compensated cirrhosis: a systematic review and meta-analysis.
Clinical outcomes with metformin use in diabetic patients with compensated cirrhosis: a systematic review and meta-analysis.
- 2024
Available online from MWHC library: 2001 - present
AIM: To investigate the impact of metformin on mortality and hepatic decompensation in people with diabetes with compensated cirrhosis. BACKGROUND: Previous studies have demonstrated a beneficial effect of metformin in patients with cirrhosis, but no improvement in liver histology. CONCLUSION: Metformin use is associated with reduced all-cause mortality, but not with the prevention of hepatic decompensation in people with diabetes with compensated cirrhosis. The mortality benefit is most likely driven by better diabetes and cardiovascular health control. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved. METHODS: Medline, Embase and Cochrane databases were searched from inception to February 2023 for studies reporting results regarding the impact of metformin on all-cause mortality and hepatic decompensation in people with diabetes with compensated cirrhosis. The risk of bias was assessed by ROBINS-I Cochrane tool. R software 4.3.1 was used for all analyses. RESULTS: Six observational studies were included in the final analysis. Metformin use was associated with reduced all-cause mortality or liver transplantation [hazard ratio (HR): 0.55; 95% confidence interval (CI) 0.37-0.82], while no benefit was shown in the prevention of hepatic decompensation (HR: 0.97; 95% CI: 0.77-1.22). In the subgroup analysis, metformin use was associated with reduced all-cause mortality or liver transplantation (HR: 0.50; 95% CI 0.38-0.65) in patients with metabolic-associated steatohepatitis cirrhosis, while two studies reported no survival benefit in patients with cirrhosis due to hepatitis C (HR: 0.39; 95% CI 0.12-1.20).
English
0954-691X
00042737-202405000-00023 [pii]
*Diabetes Mellitus
*Hepatitis C
*Liver Transplantation
*Metformin
Diabetes Mellitus/dt [Drug Therapy]
Diabetes Mellitus/ep [Epidemiology]
Hepatitis C/dt [Drug Therapy]
Humans
Liver Cirrhosis/co [Complications]
Liver Cirrhosis/di [Diagnosis]
Liver Cirrhosis/dt [Drug Therapy]
Metformin/tu [Therapeutic Use]--Automated
MedStar Health Research Institute
MedStar Washington Hospital Center
Internal Medicine Residency
MedStar Georgetown University Hospital/MedStar Washington Hospital Center
Journal Article
Meta-Analysis
Systematic Review
Available online from MWHC library: 2001 - present
AIM: To investigate the impact of metformin on mortality and hepatic decompensation in people with diabetes with compensated cirrhosis. BACKGROUND: Previous studies have demonstrated a beneficial effect of metformin in patients with cirrhosis, but no improvement in liver histology. CONCLUSION: Metformin use is associated with reduced all-cause mortality, but not with the prevention of hepatic decompensation in people with diabetes with compensated cirrhosis. The mortality benefit is most likely driven by better diabetes and cardiovascular health control. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved. METHODS: Medline, Embase and Cochrane databases were searched from inception to February 2023 for studies reporting results regarding the impact of metformin on all-cause mortality and hepatic decompensation in people with diabetes with compensated cirrhosis. The risk of bias was assessed by ROBINS-I Cochrane tool. R software 4.3.1 was used for all analyses. RESULTS: Six observational studies were included in the final analysis. Metformin use was associated with reduced all-cause mortality or liver transplantation [hazard ratio (HR): 0.55; 95% confidence interval (CI) 0.37-0.82], while no benefit was shown in the prevention of hepatic decompensation (HR: 0.97; 95% CI: 0.77-1.22). In the subgroup analysis, metformin use was associated with reduced all-cause mortality or liver transplantation (HR: 0.50; 95% CI 0.38-0.65) in patients with metabolic-associated steatohepatitis cirrhosis, while two studies reported no survival benefit in patients with cirrhosis due to hepatitis C (HR: 0.39; 95% CI 0.12-1.20).
English
0954-691X
00042737-202405000-00023 [pii]
*Diabetes Mellitus
*Hepatitis C
*Liver Transplantation
*Metformin
Diabetes Mellitus/dt [Drug Therapy]
Diabetes Mellitus/ep [Epidemiology]
Hepatitis C/dt [Drug Therapy]
Humans
Liver Cirrhosis/co [Complications]
Liver Cirrhosis/di [Diagnosis]
Liver Cirrhosis/dt [Drug Therapy]
Metformin/tu [Therapeutic Use]--Automated
MedStar Health Research Institute
MedStar Washington Hospital Center
Internal Medicine Residency
MedStar Georgetown University Hospital/MedStar Washington Hospital Center
Journal Article
Meta-Analysis
Systematic Review