Abstract Rationale Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide, with frequent exacerbations driving healthcare utilization and poor outcomes. Recent evidence suggests glucagon-like peptide-1 receptor agonists (GLP-1 RAs) may reduce COPD exacerbation risk in patients through improvements in metabolic dysregulation. This study used real-world longitudinal data to evaluate the impact of GLP-1 RA treatment on respiratory-related acute care utilization among patients with COPD. Methods A retrospective cohort study was conducted using longitudinal data from Dandelion Health (a multimodal clinical data platform) for 1,247 patients with COPD. Patients initiating GLP-1 RA therapy (n = 626) were compared to propensity score-matched controls (n = 621). Included patients had an initial COPD exacerbation on or after July 1, 2022. Primary outcomes including respiratory exacerbations and healthcare resource utilization were assessed during an 18-month baseline and 17-month post-initiation period. Difference-in-differences modeling evaluated changes in COPD exacerbation rates and healthcare utilization outcomes including emergency department visits and inpatient hospitalizations, after adjusting for baseline exacerbation frequency and accounting for a treatment washout period immediately post initiation. Negative binomial regression models estimated treatment effects in the post-period, with standard errors clustered by patient. Results Both cohorts demonstrated increasing exacerbation rates over time with similar trends in the baseline period, consistent with progressive disease; however, GLP-1 RA initiation was associated with attenuation of this trajectory. After adjusting for baseline exacerbation rates, GLP-1 RA users experienced 0.31 fewer exacerbations per patient annually compared to controls (difference-in-differences estimate: -0.31, 95% CI: -0.52 to -0.10, p = 0.005), representing an 11.9% relative reduction. The control group experienced a 33.8% increase in inpatient visit rates from baseline, while the GLP-1 RA group showed a blunted 22.4% increase post-initiation, resulting in a 19.3% lower rate of inpatient hospitalizations in the post-period (IRR=0.807, 95% CI: 0.656-0.992, p = 0.042). Emergency department visit rates (IRR=1.019, 95% CI: 0.837-1.240, p = 0.853) and length of stay per admission (adjusted difference +1.2 days, 95% CI: -0.1 to 2.6, p = 0.071) remained similar between groups. Conclusion GLP-1 RA therapy was associated with attenuation of progressive respiratory exacerbation rates and significantly reduced inpatient hospitalizations among patients with COPD. Difference-in-differences methodology strengthens conclusions by accounting for pre-existing trends between cohorts. These findings suggest GLP-1 RAs may slow disease progression and reduce resource-intensive acute care utilization, supporting prospective trials to confirm the respiratory benefits of GLP-1 RAs beyond glycemic control. This abstract is funded by: Dandelion Health
Suresh et al. (Fri,) studied this question.