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TOPLINE:

Semaglutide leads to similar weight loss in patients with inflammatory bowel disease (IBD) and obesity as in those without IBD and greater weight loss than other anti-obesity medications except tirzepatide, with no increase in IBD-specific adverse events.

METHODOLOGY:

• Although semaglutide has shown significant and sustained weight loss in the general population, its efficacy for obesity treatment in patients with IBD remains unexplored.
• This retrospective cohort study utilized data from TriNetX, a US multi-institutional database, to compare patients with obesity and IBD (n = 47,424) and those without IBD (n = 21,019).
• Propensity score matching was used to match 150 patients with obesity and IBD who were prescribed semaglutide (mean age, 47.4 years; mean body mass index [BMI], 36.9; 68% women) to an equal number of patients without IBD (mean age, 48.2 years; BMI, 37.5; 71% women).
• The IBD cohort was followed up for 18 months, while the non-IBD cohort was followed up for 19.4 months post semaglutide initiation.
• The primary objective was to assess semaglutide's effectiveness in the IBD and non-IBD cohorts. Efficacy was defined as total body weight (TBW) changes from baseline to between 6 and 15 months from the initiation of semaglutide.

TAKEAWAY:

• The change in mean TBW was similar between the IBD and non-IBD cohorts from 6 to 12 months (−16 vs −15 lb; P = .24) and from 12 to 15 months (−20 vs −21 lb; P = .49).
• Patients on semaglutide experienced a greater change in mean TBW than those on liraglutide (−13 vs −19 lb; P = .04) but a lower change in mean TBW than those on tirzepatide (−18 vs −26 lb; P = .01).
• Semaglutide resulted in a higher TBW loss than phentermine-topiramate (P < .0001), bupropion-naltrexone (P < .0001), and orlistat (P = .007).
• The risk of oral or intravenous steroid use, initiation of new advanced therapy, or any-cause emergency department visits was not different between the semaglutide and non-semaglutide cohorts. The risk for any-cause hospitalization was significantly lower in the IBD semaglutide cohort.

IN PRACTICE:

"Our study can help alleviate concerns related to the efficacy and safety of semaglutide use in patients with IBD," the authors wrote.

SOURCE:

This study, led by Aakash Desai, MD, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, was published online in Inflammatory Bowel Diseases.

LIMITATIONS:

Significant variability in TBW changes due to small sample sizes impeded the assessment of compliance with semaglutide use and adherence to lifestyle interventions. The lack of dosing information for semaglutide and other anti-obesity medications may have influenced the observed variance. Small sample sizes impeded the assessment of the efficacy of semaglutide for each medication class of advanced therapies.

DISCLOSURES:

The study did not receive any funding. Some of the authors reported serving as consultants or speakers for pharmaceutical companies. Some also served on the advisory board or data safety monitoring board of various pharmaceutical companies. One of the authors additionally owned stock options at Digbi Health.