Comparative effectiveness of tirzepatide versus bariatric metabolic surgery in adults with metabolic-associated steatotic liver disease and obesity: a multi-institutional propensity score-matched study.

OBJECTIVE: This study compared the clinical outcomes of tirzepatide versus bariatric metabolic surgery (BMS) in adults with metabolic-associated steatotic liver disease (MASLD) and obesity. METHODS: A retrospective cohort analysis was conducted using the TriNetX Global Collaborative Network. Patients with MASLD and obesity were stratified into tirzepatide and BMS groups. Propensity score matching (PSM) was used to balance baseline characteristics. The primary outcome was a composite measure including all-cause mortality, major adverse cardiovascular events (MACE), major adverse kidney events (MAKE), and major adverse liver outcomes (MALO). RESULTS: After PSM, 6199 patients were classified into each group (tirzepatide and BMS). The tirzepatide group showed a lower risk of the composite outcome, with an incidence rate of 1.9 per 100 person-years compared to 3.5 per 100 person-years in the BMS group (HR 0.47; 95% CI 0.36-0.61). Additionally, the incidence of all-cause mortality was lower in the tirzepatide group (0.4 vs. 0.9 per 100 person-years, HR 0.36, 95% CI 0.21-0.63). Similarly, MAKEs occurred less frequently in the tirzepatide group (0.7 vs. 1.8 per 100 person-years, HR 0.32, 95% CI 0.21-0.49), as did MALOs (0.8 vs. 2.0 per 100 person-years, HR 0.32, 95% CI 0.22-0.48). CONCLUSIONS: Tirzepatide offers better clinical outcomes compared to BMS in adults with MASLD and obesity, significantly reducing all-cause mortality as well as kidney- and liver-related complications. These findings highlight tirzepatide as a promising alternative to BMS, offering a less invasive approach with potential benefits in managing MASLD and obesity. This study found that tirzepatide, a medication used to treat obesity and metabolic conditions, led to better health outcomes than bariatric surgery in adults with metabolic-associated steatotic liver disease (MASLD) and obesity. Patients treated with tirzepatide had lower risks of death and serious heart, kidney, and liver complications, suggesting it may be a safer, less invasive alternative to surgery.