Risk of Suicide, Hair Loss, and Aspiration with GLP1-Receptor Agonists and Other Diabetic Agents: A Real-World Pharmacovigilance Study

Sep 12, 2024Cardiovascular drugs and therapy

Risk of Suicide, Hair Loss, and Breathing Problems with GLP-1 Drugs and Other Diabetes Medicines in Real-World Data

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Abstract

No positive signals were observed for suicide, hair loss, or aspiration risks associated with glucagon-like peptide 1 receptor agonists (GLP1-RAs).

Semaglutide and liraglutide had higher rates of reported suicidal events compared to dipeptidyl peptidase 4 inhibitors (DPP4is) and sodium-glucose transporter 2 inhibitors (SGLT2is).
GLP1-RAs were the most frequently reported class for hair loss, with semaglutide, liraglutide, and dulaglutide being the top three medications.
In contrast, aspiration events were more often reported for sitagliptin and DPP4is than for GLP1-RAs.
While GLP1-RAs showed higher reporting rates for these adverse events, they did not meet the established criteria for positive signals.

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PURPOSE: With the increasing popularity of glucagon-like peptide 1 receptor agonists (GLP1-RAs), numerous safety concerns arose pertaining to suicide, hair loss, and aspiration risks. We attempted to validate these concerns.

METHODS: We queried four pharmacovigilance databases to compare GLP1-RAs to sodium-glucose transporter 2 inhibitors (SGLT2is) with respect to these adverse events (AE): the FDA Adverse Event Reporting System (FAERS), the Australian Database of Adverse Event Notifications (DAEN), the European Medicines Agency's (EudraVigilance), and the World Health Organization-Vigibase. OpenVigil 2.1 was utilized to perform a disproportionality analysis for GLP1-RAs, SGLT2is, dipeptidyl peptidase 4 inhibitors (DPP4is), sulfonylureas, metformin, and insulin. The following indices were extracted from the FAERS database from Q4/2003 until Q3/2023: relative reporting ratio (RRR), proportional reporting ratio (PRR), reporting odds ratio (ROR), and chi-squared (χ). A positive signal was detected if PRR > 2 and χ > 4 for any drug-event pair. 2 2

RESULTS: No positive signals were observed between GLP1-RAs and either suicide, hair loss, or aspiration risks. Semaglutide [ROR = 0.60 (0.51-0.71)] and liraglutide [ROR = 0.28 (0.23-0.35)] had higher suicidal events than DPP4is and SGLT2is. GLP1-RAs were the most reported class with hair loss [ROR = 0.61 (0.60-0.64)], and semaglutide, liraglutide, and dulaglutide were the three leading medications. GLP1-RAs ranked lower with aspiration events, which were led by sitagliptin and DPP4is as a group.

CONCLUSION: GLP1-RAs exhibit higher reporting of suicide, hair loss, and aspiration events when compared to several other antidiabetic medications despite not meeting the criteria for positive signals yet. This warrants intensive monitoring and reporting.

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Risk of Suicide, Hair Loss, and Aspiration with GLP1-Receptor Agonists and Other Diabetic Agents: A Real-World Pharmacovigilance Study

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