Discontinuation of Glucagon‐Like Peptide‐1 Receptor Agonists After Bowel Obstruction or Ileus: A Nationwide, Real‐World, Database Study

OBJECTIVE: Although concerns have been raised that glucagon-like peptide-1 receptor agonists (GLP-1RAs) may increase the risk of bowel obstruction or ileus, evidence remains inconclusive. In this context of uncertainty, we examined the frequency and determinants of GLP-1RA discontinuation after hospitalization for bowel obstruction/ileus. METHODS: We conducted a retrospective cohort study using a nationwide Japanese health insurance claims database (DeSC). We identified individuals aged ≥18 years with type 2 diabetes who were hospitalized for bowel obstruction/ileus between 2016 and 2023 while receiving GLP-1RA therapy. The primary outcome was GLP-1RA discontinuation, defined as no prescription at discharge or within 6 months of discharge. Factors potentially associated with discontinuation were grouped into (1) general factors, (2) severity of bowel obstruction/ileus, and (3) potential therapeutic benefit of GLP-1RA therapy. Risk differences (RDs) for discontinuation were estimated using multivariable linear regression with robust standard errors. RESULTS: GLP-1RAs were discontinued in 86 (43.9%) of the 196 patients analyzed. Multivariable analysis revealed that surgery for bowel obstruction during hospitalization (RD = 32.1%; 95% confidence interval [CI] 11.2% to 53.0%, p = 0.003), longer length of stay (≥15 days vs. ≤7 days; RD = 32.4%; 95% CI 11.2% to 53.5%, p = 0.003), and heart failure (RD = 17.6%; 95% CI 2.1% to 33.2%, p = 0.027) were associated with GLP-1RA discontinuation. CONCLUSIONS: Nearly half of the patients discontinued GLP-1RAs after a bowel obstruction/ileus event. While GLP-1RAs were more likely to be discontinued after severe events, their potential therapeutic benefits appeared less frequently considered in continuation decisions.