Association of GLP-1 receptor agonists with herpes risks in diabetes mellitus: a target trial emulation

Dec 30, 2025BMC medicine

Link between diabetes drugs that activate GLP-1 receptors and risk of herpes infections

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Abstract

GLP-1 receptor agonist therapy is associated with a 37% increased risk of infections compared to dipeptidyl peptidase-4 inhibitors.

  • were linked to a 29% higher risk of infections compared to dipeptidyl peptidase-4 inhibitors.
  • Compared to sodium-glucose co-transporter-2 inhibitors, GLP-1 receptor agonists were associated with a 28% increased risk of herpes simplex virus and an 18% increased risk of herpes zoster.
  • Younger patients aged 18-50 years using GLP-1 receptor agonists had a significantly elevated risk for both herpes simplex virus and herpes zoster.
  • Female patients on GLP-1 receptor agonists exhibited a higher risk for herpes simplex virus infections.
  • Patients with poorly controlled diabetes (HbA1c ≥ 7%) showed increased risks for herpes simplex virus infections while on GLP-1 receptor agonists.
  • Vaccination against herpes zoster may help mitigate the risks associated with GLP-1 receptor agonist therapy.

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Key numbers

1.387
Increase in Risk
Hazard ratio for infection comparing GLP-1RA to DPP-4i.
1.294
Increase in Risk
Hazard ratio for infection comparing GLP-1RA to DPP-4i.
1.632
Higher Risk in Younger Patients
Hazard ratio for infection in younger patients (18-50 years) on GLP-1RA.

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