B24-09 Glp-1 Receptor Agonist Use Is Associated With Improved Survival and Reduced Hospitalizations in COPD Patients With Obesity

Abstract Background Obesity commonly coexists with chronic obstructive pulmonary disease (COPD), worsening respiratory symptoms, cardiometabolic burden, and mortality. Glucagon-like peptide-1 (GLP-1) receptor agonists and dual GIP/GLP-1 agonists such as tirzepatide promote weight loss and improve cardiovascular outcomes in obesity and diabetes. However, their impact on pulmonary and survival outcomes in patients with COPD and obesity remains unclear. We evaluated whether GLP-1 receptor agonist use, including tirzepatide, is associated with improved clinical and survival outcomes in adults with COPD and obesity. Methods We conducted a retrospective cohort study using the TriNetX U.S. Collaborative Network (2018-2024). Adults (≥18 years) with COPD and obesity were identified. Patients prescribed any GLP-1 or GIP/GLP-1 receptor agonist (tirzepatide, semaglutide, liraglutide, dulaglutide, exenatide, lixisenatide) comprised the exposure group; those without exposure served as controls. Propensity-score matching (1:1) was performed for age, sex, race, BMI, smoking, diabetes, hypertension, dyslipidemia, cardiovascular and renal disease, and COPD-related variables including prior exacerbations, oxygen use, and inhaler therapy intensity. Follow-up began 30 days after the index prescription and continued for up to three years. Outcomes included all-cause mortality (primary) and secondary endpoints: Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD), respiratory infections (influenza or pneumonia), hospital readmission, ICU admission, and invasive or non-invasive ventilation. Time-to-event outcomes were analyzed using Kaplan-Meier estimates and Cox proportional-hazards models to calculate hazard ratios (HR) with 95% confidence intervals (CI). Results After matching, 90,404 patients per group were analyzed (mean age 62 ± 11 y; 60% female; mean BMI ≈ 40 kg/m²; SMD 0.03 for all covariates). GLP-1 therapy was associated with lower all-cause mortality (5.1% vs 12.3%; HR 0.42 95% CI 0.40-0.43, p 0.001), fewer AECOPD (19.6% vs 21.2%; HR 0.88 0.86-0.90), lower respiratory infection rates (16.4% vs 18.5%; HR 0.87 0.85-0.89), reduced readmission rate (31.1% vs 36.0%; HR 0.79 0.78-0.81), ICU admissions (10.3% vs 13.5%; HR 0.75 0.73-0.77), invasive mechanical ventilation (2.0% vs 3.6%; HR 0.54 0.51-0.57), and noninvasive ventilation (6.9% vs 8.4%; HR 0.81 0.78-0.84) Conclusion Among adults with COPD and obesity, GLP-1 receptor agonist use—including tirzepatide—was associated with significantly lower mortality, fewer AECOPD hospitalizations, and improved cardiopulmonary outcomes over three years of follow-up. These findings suggest potential survival and pulmonary benefits of incretin-based therapy in patients with COPD and coexisting obesity, warranting prospective validation. This abstract is funded by: none