Thursday , October 19 2017
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Metformin Improved Survival of Patients with Diabetes and Cirrhosis

Patients with diabetes on metformin who were diagnosed with cirrhosis had a greater survival rate than those who discontinued metformin…. 

Lewis R. Roberts, MB, ChB, PhD, division of gastroenterology and hepatology, Mayo Clinic, Rochester, Minnesota, and colleagues conduced a cohort study, which consisted of 250 patients who had been diagnosed with cirrhosis and also had diabetes who were taking metformin at the time of the diagnosis. The mean age of the participants were 61.2 years. The participants were divided into two groups, 172 participants continued to take metformin, and the other 78 discontinued the use. Of the participants, 56.8% developed cirrhosis through nonalcoholic steatohepatitis, and 73.3% had Child-Turcotte-Pugh class A cirrhosis.

The results of the study showed that those participants who stayed on metformin therapy displayed a higher median overall survival rate when compared to those who discontinued the use of metformin, 11.6 years and 5.6 years, respectively, which yielded a P<0.0001.

The study showed, five year and ten year survival rates were higher among those who continued metformin, 77.5% versus 53.1% and 55.2% versus 30.7%, respectively. The class A cirrhosis patients in the continuous group showed better liver function (P=0.01). The participants that continued the metformin therapy had better survival (P=0.005), and showed a 57% decrease in risk for mortality. Therefore, concluding metformin should be continued in patients with cirrhosis if there is no specific contraindication.

According to researchers, during the follow-up none of the patients developed lactic acidosis. Dr. Roberts and his colleagues stated, "Our findings strongly suggest that continuation of metformin improves the survival of nonalcoholic steatohepatitis-related cirrhotic patients with diabetes. Validation of these results in a larger cohort would support continuation of metformin use in nonalcoholic steatohepatitis-related cirrhosis."

Practice Pearls:
  • Participants who stayed on metformin therapy displayed a higher median overall survival rate when compared to those who discontinued the use of metformin, 11.6 years and 5.6 years, respectively.
  • The study showed, five year and ten year survival rates were higher among those who continued metformin, 77.5% versus 53.1% and 55.2% versus 30.7%, respectively.

http://onlinelibrary.wiley.com/doi/10.1002/hep.27199/abstract: http://www.healio.com/hepatology/cirrhosis-liver-failure/news/online/%7Bec5a3a61-e873-492d-9f22-94496b5fb16e%7D/metformin-improved-overall-survival-in-patients-with-diabetes-cirrhosis