Tolerability and Effectiveness of Glucagon-Like Peptide-1 Receptor Agonists in Patients with Inflammatory Bowel Disease

📖 Top 20% JournalMar 12, 2025Digestive diseases and sciences

How Well Glucagon-Like Peptide-1 Receptor Agonists Work and Are Tolerated in People with Inflammatory Bowel Disease

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Abstract

Of 272 patients with obesity and inflammatory bowel disease, 61% achieved at least 5% total weight loss after 12 months of GLP-1 receptor agonist treatment.

Among patients who completed 12 months of treatment, 42% achieved at least 10% total weight loss.
Adverse events were reported in 40% of patients, primarily gastrointestinal in nature.
24% of patients discontinued GLP-1 receptor agonists, with 48% citing adverse events or tolerability issues.
There was no significant difference in IBD flare rates before and after starting GLP-1 receptor agonists (17% vs. 13%).
Anti-TNF therapy exposure did not significantly influence the likelihood of achieving 5% total weight loss compared to other IBD treatments.

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PURPOSE: Glucagon-like peptide 1 receptor agonists (GLP-1 RA) have transformed obesity management, but their safety and efficacy in patients with inflammatory bowel disease (IBD) warrants further evaluation.

METHODS: This retrospective cohort study included adults with obesity and a diagnosis of IBD who were treated with GLP-1 RA within a large healthcare network. Primary outcomes were ≥ 5% total weight loss (TWL) at 12-months post initiation, and IBD flares, comparing 12-months pre- and post-GLP-1 RA initiation. Secondary outcomes included ≥ 10% TWL, adverse events (AE), and discontinuation of GLP-1 RA. Secondary analysis assessed anti-TNF exposure and primary outcomes. Statistical analysis used paired t-test for continuous outcomes, and McNemar's χtest for dichotomous outcomes. Logistic regression was performed for multivariable analysis of the primary efficacy outcome. 2

RESULTS: Of 272 patients included, 175 completed at least 12 months of GLP-1 RA. Among these individuals, 61% achieved ≥ 5% TWL and 42% achieved ≥ 10% TWL. AEs occurred in 40%, and were primarily gastrointestinal (93%). GLP-1 RA were stopped in 24% of patients (48% for AE/tolerability and 18% for access/cost issues). There was no difference in the proportion of patients with IBD flares within 12 months pre vs. post GLP-1 RA (17% vs. 13%, P = 0.40). Anti-TNF exposure did not affect the likelihood of achieving ≥ 5% TWL in comparison with other IBD therapies (66% vs. 58%, P = 0.33).

CONCLUSIONS: This study supports the safety, tolerability, and effectiveness of GLP-1 RA for treatment of obesity in patients with IBD.

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