Cureus · Nov 19, 2025

Evaluation of the Short-Term Effect of Tirzepatide on Liver Fibrosis Biomarkers Stratified by the Fibrosis-3 Index (FIB-3) in Patients With Type 2 Diabetes Mellitus

By Yamamori D, Kitao T, Masuda S et al.

Aims The primary objective of this study is to evaluate the short-term impact of tirzepatide on liver fibrosis markers, specifically the Fibrosis-3 index (FIB-3), Fibrosis-4 index (FIB-4), and aspartate aminotransferase-to-platelet ratio index (APRI), in patients with type 2 diabetes mellitus (T2DM). The secondary objective is to assess the correlations between FIB-3 and established fibrosis indices, including FIB-4 and APRI. Methods A total of 87 patients were stratified into two subgroups based on their FIB-3 score at the initiation of tirzepatide, following the FIB-3 classification: Group 1 (G1) (FIB-3 <1.5; n=68) and Group 2 (G2) (FIB-3 ≥1.5; n=19). We evaluated the changes in FIB-3, FIB-4, and APRI three months after the initiation of tirzepatide in each subgroup. Subsequently, we compared the changes (Δ) in FIB-3, FIB-4, and APRI scores across the two subgroups. Additionally, we investigated the baseline parameters and changes in these parameters correlated with Δ FIB-3. Correlation coefficients between FIB-3 and both FIB-4 and APRI were calculated. Results Only APRI exhibited a significant decrease in G1 (p=0.029), but FIB-3 (p<0.001), FIB-4 (p=0.005), and APRI (p<0.001) decreased significantly in G2. Δ FIB-3 (p=0.003), Δ FIB-4 (p=0.001), and Δ APRI (p<0.001) in G2 were significantly greater than those observed in G1. Δ FIB-3 was inversely correlated with baseline FIB-3 and positively correlated with Δ γ-glutamyl transpeptidase. FIB-3 demonstrated strong correlations with FIB-4 (r=0.81) and APRI (r=0.85). Conclusions In patients with T2DM, those with higher baseline FIB-3 values exhibited a more pronounced reduction in liver fibrosis markers during the short-term period following the initiation of tirzepatide therapy. FIB-3 exhibited robust associations with established fibrosis markers.

doi.org/10.7759/cureus.97279 Open access PubMed 41431568 Interventions