Changes in Transient Elastography with Glucagon-Like Peptide-1 Receptor Agonist Use in Metabolic Dysfunction-Associated Steatotic Liver Disease: A Real-World Retrospective Analysis

Abstract

Introduction:

Current guidelines recommend the use of glucagon-like peptide-1 receptor agonists (GLP-1RAs) in the treatment of metabolic dysfunction-associated steatotic liver disease (MASLD), especially in patients with comorbid diabetes and obesity. This study investigated the effects of GLP-1RAs on hepatic steatosis and fibrosis in patients with MASLD, as measured by changes in vibration-controlled transient elastography (VCTE) and other clinical parameters in a real-world clinical setting.

Methods:

We conducted a single-center, retrospective analysis of 96 patients with MASLD from a multidisciplinary care clinic who completed VCTE at baseline and follow-up within 6–24 months to compare changes in controlled attenuation parameter (CAP) and liver stiffness measurement (LSM), as well as other metabolic markers, between GLP-1RA users and nonusers using two-sample t-tests and Wilcoxon rank-sum tests. We also assessed whether improvements in hepatic steatosis, defined as a change in CAP >38 dB/m as previously described in the literature, were associated with improvement in fibrosis.

Results:

GLP-1RA use resulted in significant improvements in weight (−8.1 kg vs. −3.5 kg, P = 0.009), body mass index (BMI) (−2.9 kg/m² vs. −1.3 kg/m², P = 0.012), alanine aminotransferase (−15.0 IU/L vs. −4.0 IU/L, P = 0.017), aspartate aminotransferase (−5.0 IU/L vs. −1.0 IU/L, P = 0.021), glycated hemoglobin (HbA1c) (−0.7% vs. 0.1%, P = 0.019), and CAP (−59.9 dB/m vs. −29.1 dB/m, P = 0.016). Responders also had significant improvements in weight (−9.2 kg vs. −1.9 kg, P < 0.001), BMI (−3.3 kg/m² vs. −0.7 kg/m², P < 0.001), diastolic blood pressure (−6.1 mmHg vs. −0.7 mmHg, P = 0.028), HbA1c (−0.8% vs. 0.3%, P < 0.001), and LSM (−1.5 kPa vs. 0.1 kPa, P < 0.001).

Conclusions:

Patients with MASLD treated with GLP-1RAs showed significant improvements in hepatic steatosis and multiple other metabolic parameters, with weight loss as the proposed mechanism for this liver improvement. In addition, change in CAP >38 dB/m was associated with improvements in LSM and other metabolic parameters, suggesting the clinical utility of VCTE in the surveillance of MASLD.