Effect of Injectable Dual and Single Agonist Glucagon-Like Peptide-1 Based Therapy on Inflammatory Bowel Disease Activity Among Patients with Obesity

Background and Aims

Obesity is a risk factor for relapsing inflammatory bowel disease. GLP-1 and dual GLP-1/GIP agonists may offer superior weight loss; however, their effect on inflammatory bowel disease remains unknown. In this study, we assessed outcomes in patients with IBD and obesity using these medications.

Methods

A retrospective, propensity-matched analysis was conducted using data from The OneFlorida+ network. We evaluated patients with IBD and obesity prescribed GLP-1-based therapy (liraglutide, semaglutide, or tirzepatide) versus those without. 562 patients prescribed GLP-1-based therapies were matched 1:1 to controls based on demographics and comorbidities.

Results

No differences in GLP-1 users versus non-users with respect to all-cause hospitalization, IBD-hospitalization, IBD-related surgery, or pancreatitis were seen. Use of semaglutide reduced the risk of IBD-related surgery (HR 0.33, CI 0.13-0.83). Among 89 tirzepatide users, none required IBD-related surgery versus 2 matched controls. Black GLP-1 users had an increased risk of all-cause hospitalizations (HR 1.59, CI 1.11–2.29) but not IBD-related hospitalization or IBD-related surgery. Steroid use was comparable between groups. GLP-1 use significantly reduced serum CRP.

Conclusions

Semaglutide appeared to lower the risk of IBD-related surgery. Black patients using GLP-1 therapy had an increased risk of all-cause hospitalization. Tirzepatide showed no significant difference regarding primary endpoints; however, the sample size was small. Overall, all GLP-1-based therapies were well tolerated among obese patients with IBD. Larger studies are warranted to understand the therapeutic potential of GLP-1-based treatment in this patient population.

Graphical Abstract