Glucagon-Like 1 Receptor Agonist Use Was Associated With Improved Outcomes in Patients With Inflammatory Bowel Disease: A Large Real-World Database Study

Abstract INTRODUCTION The utilization of glucagon-like peptide 1 receptor agonists (GLP-1RA) is rising for the treatment of obesity, with emerging data to suggest that they may also exert anti-inflammatory effects beyond weight loss. As the prevalence of obesity rises in patients with inflammatory bowel disease (IBD), there is mounting interest in understanding the effect that GLP-1RAs have on IBD-associated outcomes. METHODS Utilizing the Mayo Clinic Platform, which provides de-identified clinical data on approximately 8 million patients, we performed a case-control study to evaluate the impact that use of GLP-1RAs had on IBD-specific outcomes of corticosteroid use, emergency department (ED) visits, hospitalizations, intestinal surgery, and mortality in patients with ulcerative colitis (UC) and Crohn’s disease (CD). Patients were included if a diagnosis code for CD or UC occurred at least 4 times. GLP-1RA exposure was defined as having a GLP-1RA (liraglutide, semaglutide, tirzepatide) ordered or administered at least twice. IBD cases with GLP-1RA exposure were propensity score matched on age, sex, type 2 diabetes mellitus, and body mass index (BMI). RESULTS In total, there were 580 patients with IBD identified who were treated with a GLP-1RA (322 UC, 258 CD) who were matched to controls with IBD who were not treated with GLP-1RA. Of the 322 individuals with UC, the rates of corticosteroid use (46.6% vs 85.1%, OR 0.15, 95% CI 0.11-0.22, p 0.001), hospitalization (40.9% vs 65.9%; OR 0.35, 95% CI 0.25-0.48, p 0.001), intestinal resection (6.5% vs 20.8%; OR 0.27, 95% CI 0.16-0.45, p 0.001) and mortality (4.6% vs 22%; OR 0.17, 95% CI 0.10-0.30, p 0.001) were lower in the GLP-1RA treated patients as compared to controls (Figure 1). Frequency of ED visits was similar between groups (51.9% vs 56.5%; OR 0.73, 95% CI 0.52-1.00, p = 0.048). In patients with CD, rates of corticosteroid use (39.9% vs 76.0%, RR 0.53), ED visits (41.9% vs 52.7%, RR 0.80), hospitalization (30.6% vs 55.8%, RR 0.55), intestinal resection (17.8% vs 53.9%, RR 0.33), and mortality (5.8% vs 10.9%, RR 0.53). CONCLUSIONS The use of GLP-1 receptor analogs was associated with improved IBD-specific outcomes in patients with UC and CD. Further study is needed to better define the true impact of GLP1RA on IBD-specific outcomes, ideally with more granular measures of disease activity.