GLP-1 drugs linked to fewer liver crises and lower death risk in older adults

Analysis of nearly 88,000 older adults with fatty liver disease found lower rates of liver decompensation, hospitalisation and death among GLP-1 users, but higher risks of osteoporosis and retinopathy.

A class of diabetes and weight-loss medicines built around GLP-1 receptor agonists may do more than help control blood sugar and body weight, according to research published in Age and Ageing. In older adults with metabolic dysfunction-associated steatotic liver disease, the drugs were linked with a lower risk of serious liver complications and a markedly reduced chance of death from any cause.

The study analysed medical records for almost 88,000 people aged over 65, with an average age of about 72, comparing those treated with GLP-1 drugs with similar patients who did not receive them. Researchers found that treatment was associated with a 28% lower risk of liver decompensation, a stage at which the liver can no longer function properly, and with fewer hospital admissions overall.

The strongest finding was a 45% reduction in all-cause mortality among patients taking the medicines. However, the study also found higher rates of osteoporosis and retinopathy, an eye disease affecting the retina, in the treated group. There was no clear reduction in the risk of heart attack or stroke, suggesting that the benefits seen in this analysis may be more closely tied to liver-related outcomes than to cardiovascular protection.

The new findings fit with a growing body of evidence that GLP-1 medicines may help people with fatty liver disease beyond their established role in diabetes care. A large retrospective study published in PubMed found lower risks of heart failure, clinically significant portal hypertension and death in patients with metabolic dysfunction-associated steatotic liver disease, while a meta-analysis in Gut, the BMJ’s gastroenterology journal, linked the drugs with fewer major liver-related complications and less hepatic decompensation. Other studies have also reported lower risks of cirrhosis and, in some cohorts, reduced mortality. Even so, the newer work and earlier research both suggest that any broader liver benefit comes with the need to monitor for possible bone and eye-related harms.