TOPLINE

Patients with stable inflammatory bowel disease (IBD) and comorbid obesity and/or diabetes who started GLP-1 receptor agonists (semaglutide or tirzepatide) alongside ongoing treatment did not have a lower risk for the relapse of IBD or safety events.

METHODOLOGY

• Obesity has been linked to worse outcomes in IBD. It remains unclear whether newer GLP-1 receptor agonists improve clinical outcomes in patients with IBD who also have comorbid obesity and/or diabetes.
• Researchers emulated a randomized trial using observational claims data from the US between 2018 and 2023 to compare the outcomes of initiating semaglutide or tirzepatide with those of not initiating them.
• They included adults with stable IBD and comorbid obesity and/or diabetes and divided them into two cohorts: Cohort 1 included patients on 5-aminosalicylates or no IBD-related therapy, and cohort 2 included patients on immunomodulators and/or advanced therapies.
• Each patient who started a GLP-1 receptor agonist was propensity score matched with a similar patient who did not start the medication.
• The primary outcome was the relapse of stable IBD over 12 months. Secondary outcomes included safety events, discontinuation of treatment, and treatment escalation or switch.

TAKEAWAY

• Cohort 1 included 2028 GLP-1 initiators (mean age, 63 years; 63% women) who were matched with an equal number of noninitiators. Cohort 2 included 346 GLP-1 initiators (mean age, 59 years; 62% women) who were matched with an equal number of noninitiators.
• The 12-month risk for relapse did not differ significantly between GLP-1 initiators and noninitiators in either cohort.
• No significant difference in the occurrence of safety events was observed between the two groups in either cohort. GLP-1 discontinuation at 1 year was common (47% in cohort 1 and 41% in cohort 2).
• In cohort 1, the risk for IBD-directed treatment escalation or switch was lower in GLP-1 initiators than in noninitiators (risk ratio, 0.76; 95% CI, 0.61-0.95). In cohort 2, the risk did not differ between the two groups.

IN PRACTICE

“In summary, using a trial emulation framework, we observed that GLP1 [receptor agonist] initiation was not superior to noninitiation in improving clinical outcomes in stable patients with IBD in remission, with comorbid obesity and/or diabetes,” the authors of the study wrote.

SOURCE

The study was led by Kuan-Hung Yeh, UC San Diego, and Dhruv Ahuja, Indira Gandhi Hospital, New Delhi, India. It was published online in Clinical Gastroenterology and Hepatology.

LIMITATIONS

Researchers used claims data and lacked clinical or endoscopic disease measures. The study was observational and could not rule out residual confounding. Some patients may have been misclassified as noninitiators because GLP-1 drugs may have been purchased without insurance.

DISCLOSURES

The study received support from an International Organization for the Study of Inflammatory Bowel Disease Operating Grant awarded to the corresponding author, who also received support from the National Institute of Diabetes and Digestive and Kidney Diseases grant. Three authors reported receiving awards, grants, or speaker fees and/or being on consulting and/or advisory boards of multiple commercial and noncommercial sources.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.