GLP-1s & IBD

GLP-1s & IBD

January 7, 2025

Issue 01

Clinical Question

Do GLP-1s impact IBD outcomes?

Editor’s Bottom Line

Observational data such as these have many limitations, but align with other evidence that GLP-1 antagonists have favourable effects on the activity of inflammatory bowel disease.

Reference

Gorelik Y, Ghersin I, Lujan R, et al. GLP-1 analog use is associated with improved disease course in inflammatory bowel disease: a report from the Epi-IIRN. J Crohn’s Colitis. Epub ahead of print Oct 23, 2024. https://academic.oup.com/ecco-jcc

Synopsis

To determine the impact of glucagon-like peptide 1 (GLP-1) analog use on IBD outcomes, researchers in Israel examined dispensing data and medical records for a nationwide cohort of 3,737 patients with IBD treated between 2005 and 2021 who also had Type 2 diabetes mellitus (DM2). Of these, 633 received GLP-1 analogs.

The data totaled 24,338 patient-years with a median follow-up of six years per patient. The group was divided roughly evenly by IBD subtype. Compared to those who did not receive a GLP-1 analog, those who did were younger and had a higher body mass index, higher hemoglobin A1c levels and received insulin.

The primary outcome of the analysis was a composite endpoint of steroid dependency, IBD treatment escalation, IBD-related hospitalization, abdominal/perianal surgery, or death, during follow-up. Each component measure also represented a secondary endpoint.

Multivariate analysis accounting for demographic variables as well as features of IBD and DM2, medication use and laboratory measurements found that GLP-1 analog administration was associated with a lower risk of the composite endpoint (adjusted Hazard Ratio [aHR]: 0.74; 95% Confidence Interval [CI]: 0.62–0.89). The lowered risk was similar in both ulcerative colitis (UC) and Crohn’s disease (CD) patients.

Analysis of the secondary outcomes showed that GLP-1 analog use only led to a reduced risk of hospitalization in patients with UC (aHR: 0.63; 95% CI, 0.45–0.9) but not those with CD (aHR: 0.82; 95% CI, 0.65–1.05). Additionally, there were no differences in the other individual components of the composite endpoint among those who did or did not use GLP-1 analogs.

When the authors parsed the data according to the presence of obesity, they found GLP-1 analog use was linked with a protective effect only among those with obesity (aHR: 0.61; 95% CI, 0.5–0.77) and the drugs did not have an effect on IBD outcomes among non-obese IBD patients (aHR: 0.94; 95% CI, 0.67–1.31).

Details

Study Design: Nationwide cohort analysis
Funding: The Leona M. and Harry B. Helmsley Charitable Trust.
Allocation: Not applicable
Setting: Multicenter
Level of Evidence: 2b