GLP-1 RAs bring a number of benefits in IBD

The use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) among patients with inflammatory bowel disease (IBD) appears to result in favourable clinical outcomes, as shown in two retrospective studies.

TriNetX-based CD cohort

In the first study that involved a large real-world cohort of adults with Crohn’s disease (CD), GLP-1 RA users had significantly reduced steroid dependence (52.9 percent vs 62.8 percent; p=0.0009) and fewer hospitalizations (2.3 percent vs 3.7 percent; p=0.02) over 12 months when compared with nonusers. [Ganju N, et al, CCC 2026]

In Kaplan–Meier survival analysis of steroid-free survival, GLP-1 RA use was associated with significantly reduced hospitalization risk and improved persistence on advanced IBD therapies over 12 months (hazard ratio, 0.74, 95 percent confidence interval [CI], 0.64–0.87; p=0.0002), reported first author Dr Nakul Ganju from Howard University Hospital in Washington, DC, US.

Rates of major abdominal surgery were similar between GLP-1 RA users and nonusers, and there was no signal of increased surgical risk, Ganju noted.

“Findings remained robust in subgroup and sensitivity analyses, including restriction to patients on advanced IBD therapies at index,” he added.

Mayo Clinic Platform-based IBD cohort

The second study also showed substantially reduced corticosteroid use and hospitalization with GLP-1 RA use vs nonuse among ulcerative colitis (UC) patients (corticosteroid use: 46.6 percent vs 85.1 percent; odds ratio [OR], 0.15, 95 percent CI, 0.11–0.22, p<0.001; hospitalization: 40.9 percent vs 65.9 percent; OR, 0.35, 95 percent CI, 0.25–0.48; p<0.001). [Johnson A, et al, CCC 2026]

Additionally, GLP-1 RA users were less likely to undergo intestinal resection (6.5 percent vs 20.8 percent; OR, 0.27, 95 percent CI, 0.16–0.45; p<0.001) and had markedly lower mortality (4.6 percent vs 22 percent; OR, 0.17, 95 percent CI, 0.10–0.30; p<0.001) compared with nonusers. No significant between-group difference was seen in the frequency of ED visits (51.9 percent vs 56.5 percent; OR, 0.73, 95 percent CI, 0.52–1.00; p=0.048).

For patients with CD, all studied outcomes were more favourable among GLP-1 RA users vs nonusers, noted first author Dr Amanda Johnson from the Mayo Clinic in Rochester, Minnesota, US.

GLP-1 RA use among CD patients was associated with significantly lower rates of corticosteroid use (39.9 percent vs 76 percent; OR, 0.21, 95 percent CI, 0.14–0.31; p<0.001), ED visits (41.9 percent vs 52.7 percent; OR, 0.65, 95 percent CI, 0.46–0.91; p=0.014), hospitalization (30.6 percent vs 55.8 percent; OR, 0.35, 95 percent CI, 0.24–0.50; p<0.001), intestinal resection (17.8 percent vs 53.9 percent; OR, 0.19, 95 percent CI, 0.12–0.28; p<0.001), and mortality (5.8 percent vs 10.9 percent; OR, 0.51, 95 percent CI, 0.26–0.97; p=0.038).

Potential adjunct in IBD treatment

These data provide evidence that GLP-1 RAs exert anti-inflammatory effects beyond weight loss and support these drugs as a safe and potentially beneficial adjunct in IBD management, according to the authors.

Ganju and Johnson emphasized the clinical implications of their findings, noting that GLP-1 RAs are increasingly prescribed for obesity, the prevalence of which is rising in patients with IBD.

“Prospective studies and guideline development are urgently needed to define their role in integrated IBD and metabolic care,” Ganju said.

Study details

For the first study, Ganju and colleagues used data from the TriNetX research network and identified adult patients with CD and overweight or obesity. Patients who used GLP-1 RAs were propensity-score matched to those who had no exposure. A total of 546 GLP-1 RA users and 546 nonusers were included in the analysis, with well-balanced demographic and clinical factors. Steroid dependence was the primary outcome. Secondary outcomes included all-cause hospitalization, Crohn’s-related surgery, and persistence on advanced IBD therapy.

For the second study, Johnson and colleagues used data from the Mayo Clinic Platform and established a cohort of 580 patients with IBD (322 had UC, 258 had CD) who received a GLP-1 RA (liraglutide, semaglutide, or tirzepatide). These patients were propensity score matched to controls with IBD who were not treated with GLP-1RA. IBD-specific outcomes included corticosteroid use, ED visits, hospitalizations, intestinal surgery, and mortality.