GLP-1 RAs in IBD

January 27, 2026

Issue 02

Clinical Question

Are glucagon-like peptide-1 receptor agonists safe and effective in patients with inflammatory bowel disease?

Editor’s Bottom Line

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are well tolerated among patients with inflammatory bowel disease (IBD) and may even improve IBD-related outcomes.

Reference

Maracle B, Quan S, Hamilton P, et al. Systematic Review: Efficacy, Safety and Metabolic Outcomes of GLP-1 Receptor Agonists in Inflammatory Bowel Disease. Aliment Pharmacol Ther. 2026;63(1):17–39. https://doi.org/10.1111/apt.70485

Synopsis

This systematic review examined outcomes of GLP-1 RA therapy in IBD patients by analyzing 14 studies identified in MEDLINE, Embase, Cochrane Library, and ClinicalTrials.gov through September 2025. The analysis included 13 retrospective cohorts and one case-control study including patients with IBD and comorbid obesity, type 2 diabetes, or both. Study populations ranged from 16 to 61,927 participants across diverse geographic locations, including 10 US studies, two Danish, one Spanish and one Israeli study. Follow-up periods varied from three months to seven years.

Weight-related outcomes were consistently favorable, with 10 of 14 studies demonstrating significant reductions in body weight, BMI, or percent weight loss. Mean weight reductions ranged from 3.9% to 11.5%, with some studies showing comparable effectiveness to non-IBD populations. Two studies found no significant differences between IBD and non-IBD patients receiving GLP-1 RAs, while one study reported superior weight loss in non-IBD patients.

Metabolic improvements were documented in four studies, including significant reductions in hemoglobin A1c levels and favorable lipid profile changes. HbA1c reductions ranged from 0.3% to 0.88%, with some studies showing greater improvements in non-IBD populations. Lipid changes were mixed, with some studies reporting beneficial effects on HDL and triglycerides.

Safety outcomes appeared consistent with those reported in non-IBD populations. Specifically, gastrointestinal adverse events included nausea (2.2%–30.5%), diarrhea (2.2%–12.5%) and constipation (2.9%–25%). Discontinuation rates in smaller cohorts ranged from 11% to 24%, primarily due to gastrointestinal intolerance. Importantly, no studies reported an increase in IBD exacerbation rates attributable to GLP-1 RA use.

Notably, there were some encouraging IBD-specific signals. Large administrative datasets consistently demonstrated associations with reduced corticosteroid use (Hazard Ratio [HR]: 0.54–0.66), hospitalizations (HR: 0.73–0.74) and IBD-related surgery (HR: 0.55–0.84). Biomarker studies showed stability or improvement in inflammatory markers, with two studies reporting significant CRP reductions.

Quality assessment revealed variable study quality, though no studies were excluded due to poor methodology. Major design limitations noted by the authors included retrospective design, heterogeneous populations, limited objective disease activity measures and potential residual confounding.

Details

Study Design: Systematic review of observational studies
Funding: Not specified
Allocation: Not applicable
Setting: Multicenter
Level of Evidence: 1a