Glucagon-Like Peptide 1 Receptor Agonists are Associated With Reduced Risk of Hepatic Encephalopathy in Cirrhosis

GOALS: This retrospective cohort study investigates whether weight loss-dose glucagon-like peptide 1 receptor agonist (GLP-1 RA) therapy is associated with the risk of hepatic encephalopathy (HE) among patients with cirrhosis. BACKGROUND: Hepatic encephalopathy (HE) is associated with prolonged intestinal transit time. GLP-1 RA therapies, particularly at weight-loss-promoting doses, prolong gastrointestinal transit time, but there is limited data on HE risk in cirrhotic GLP-1 RA users. STUDY: Patients with cirrhosis from a single quaternary care medical center were examined between 2017 and 2024. The primary exposure was the presence or absence of therapeutic-dose GLP-1 RA treatment (≥1 mg/wk semaglutide or ≥7.5 mg/wk tirzepatide for ≥6 mo). The primary outcome was time to incident HE. Survival analyses were conducted with competing risks for death or liver transplantation, and adjusting for sociodemography and comorbidity. RESULTS: A total of n=2557 patients with cirrhosis, of which n=139 met GLP-1 RA use criteria. GLP-1 RA users were less likely to develop HE (3.6% vs. 18.7%, P