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Metformin use increased survival rate in patients with cirrhosis, diabetes

Patients with diabetes who continued metformin use after diagnosis of cirrhosis had a better survival rate compared with those who discontinued it, according to new data.

Medical records of 250 patients with diabetes and diagnosed with cirrhosis between 2000 and 2010 were reviewed by researchers, including Lewis R. Roberts, MB, ChB, PhD, division of gastroenterology and hepatology, Mayo Clinic, Rochester, Minn., and included in the cohort. Of all the patients, 142 were male, 181 had Child-Pugh class A cirrhosis and 142 had nonalcoholic steatohepatitis-related cirrhosis. All patients were using metformin at the time of cirrhosis diagnosis; however, 172 patients continued it and 78 discontinued use. The median time of continued metformin use was 26.8 months.

Lewis R. Roberts

Researchers found that patients who continued to use metformin ultimately had better liver function, including a large proportion of the patients with Child-Pugh class A cirrhosis (P=.01) and those with lower MELD scores (P<.001). The patients who continued to use metformin had a greater median survival rate after cirrhosis diagnosis compared with those who did not after diagnosis (11.8 years vs. 5.6 years). Survival rates of patients who continued metformin use were greater at 5 years (77.5% vs. 53.1%) and 10 years (55.2% vs. 30.7%) compared with those who discontinued. Of the patients with NASH-related cirrhosis, 98 continued metformin use and had a greater median survival rate of 12.1 years compared with the 44 who discontinued it and had a median survival rate of 5.1 years (HR=0.33; 95% CI, 0.17-0.63).     

Univariate analysis showed that continued use of metformin was associated with a better survival rate among patients with cirrhosis and diabetes (HR=0.43; 95% CI, 0.28-0.66).

“The current practice of many physicians is to switch diabetic patients who are on metformin from metformin to other drugs such as insulin when the diagnosis of cirrhosis is made, due to concerns about side effects, particularly metabolic acidosis," Roberts told Healio.com/Hepatology. "Our study suggests that most patients with cirrhosis are at low risk of metabolic acidosis from metformin and, further, that metformin use may have a positive effect of prolonging the lives of diabetic patients with cirrhosis. If this finding is reproduced, it may lead to a change in current medical practice.”

Disclosure: The researchers report no relevant financial disclosures.