Efficacy and tolerability of liraglutide for refractory bile acid diarrhoea

Background Bile acid sequestrants are used for the treatment of bile acid diarrhoea (BAD) but they are not always effective and may be tolerated poorly. Other treatment options for BAD are limited. Both randomised controlled trial and case series data suggest that liraglutide, a glucagon-like peptide-1 receptor agonist, may be effective in BAD but studies are scarce. Aims To report efficacy and tolerability of liraglutide in a cohort of patients with refractory BAD who had either not responded to or were intolerant of the bile acid sequestrants colestyramine and colesevelam. Methods Data were collected prospectively for patients with refractory BAD (7-day 23-seleno-25-homo-tauro-cholic acid retention <15%) receiving liraglutide in Leeds Teaching Hospitals NHS Trust. Clinical response to, and tolerability of, liraglutide was assessed by comparing mean daily stool frequency before and after treatment initiation and monitoring for adverse events. Clinical responders were classified as patients who had a reduction in daily stool frequency of ≥50% at 2–3 months in whom the drug was continued. Results Thirty-one (21 (67.7%) female, mean age at commencement 46.6 years) patients with refractory BAD received liraglutide between November 2022 and July 2026. Bile acid sequestrants were ineffective or intolerable in all patients. Clinical response occurred in 19 (61.3%) patients and a partial response in a further seven (22.6%). Among clinical responders, mean daily stool frequency fell from 10.4 at baseline to 3.0 at 2–3 months (p<0.001). More responders were female, had type II BAD and were passing 10 or more stools per day at baseline. In addition, mean weight was lower and mean daily stool frequency higher at baseline in clinical responders. Only one patient discontinued liraglutide due to adverse events. Conclusions Liraglutide is an effective treatment for refractory BAD and is well tolerated.