P1039Effectiveness and Safety of GLP-1 Receptor Agonists in Reducing Ostomy Output Among IBD Patients with Ileostomies

Background Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly used therapies for weight management and type 2 diabetes. The effect of GLP-1RAs on reduction of gastrointestinal motility is well described. Inflammatory bowel disease (IBD) patients with ileostomies often suffer from high ostomy output. We hypothesized that GLP-1RAs can reduce ostomy output in IBD patients with an ileostomy. Methods We performed a retrospective analysis of IBD patients with ileostomies created at the University of Chicago between April 2021-April 2025 and who were subsequently prescribed GLP-1RAs. Primary analysis was ostomy output before and after starting a GLP1-RA defined as patient-reported frequency of ostomy appliance emptying. Secondary analysis included changes in body mass index (BMI), change in disease activity (active disease defined as C-reactive protein (CRP) >5 mg/L or per endoscopic report), and safety including adverse events (AEs) of specific interest (pancreatitis, bowel obstruction or ileus, and gallbladder disease). Results 13 (7 CD, 5 UC, 1 IBD-U) patients were included. 12 patients had end ileostomies, and 1 patient had a loop ileostomy. 6 (46.2%) patients had type 2 diabetes, 4 (30.8%) had hypertension, and 1 (7.7%) had hyperlipidemia at baseline. 6 patients were on an IBD therapy at baseline. 11 patients were initiated on semaglutide and 2 were initiated on tirzepatide. 11 patients were prescribed GLP-1RAs for weight management, 6 for type 2 diabetes management, and 4 for high ostomy output in addition to either weight or diabetes management. Median time to follow up from GLP-1RAs start was 340 days (IQR 232-376). Median number of ostomy emptyings per day was 6 (IQR 4.5-8.5), which decreased to 4 (4-4.5) at follow up, P = 0.0139. Median BMI at baseline was 32.5 kg/m2 (IQR 28.6-40.3) and median follow up BMI was 29.95 kg/m2 (IQR 25.47-33.8). 3 (23.1%) patients had active IBD by an objective marker before GLP-1RA start; 2 per CRP and 1 per ileoscopy. Of the 6 patients with at least one follow up objective measure of disease activity (5 CRP, 1 ileoscopy), 0 had evidence of active disease. No patient changed IBD therapy during follow-up. Drug-related AEs included nausea (n = 3), abdominal pain (n = 3), dry mouth (n = 1), and dehydration (n = 1). Two patients had bowel obstructions related to peristomal hernias that were not deemed to be related to the GLP1-RA. No AEs of special interest were reported. (Table 1). Conclusion GLP-1RAs in IBD patients with ileostomy appear to be effective in reducing ostomy output, BMI reduction, and are generally well tolerated. Conflict of interest: Duty, Charlotte M.: No conflict of interest Bhondwe, Khushi: No conflict of interest Pekow, Joel R.: CVS Health - Consulting Abbvie, Eli Lilly, Pfizer, Johnson and Johnson - Stocks Cohen, Russell: Personal Fees: Abbvie, Celgene, Eli Lilly, Hospira, Janssen, Pfizer, Sandoz Biopharma, Takeda, UCB Pharma Non-financial Support: Abbvie Rubin, David T.: Grant support: Takeda Pharmaceuticals Consultant: Abbvie, Abivax SA, Altrubio, Athos Therapeutics, Inc, Bristol-Myers Squibb, Celltrion, Connect BioPharma, Eli Lilly & Co., Genentech (Roche) Inc., Iterative Health, Janssen Pharmaceuticals, Johnson & Johnson, Merck & Co., Mirador, Odyssey Therapeutics, Pfizer, Sanofi, Spyre, Takeda Pharmaceuticals, Vedanta Biosciences, and Ventyx. Dr. Krugliak Cleveland, Noa: Consultant for NeuroLogica, Johnson & Johnson, GE HealthCare, Abbive Inc., and Sanofi