Colon to Rectum
J Crohns Colitis. 2025;19(4):jjae160
GLP-1 analog use is associated with improved disease course in inflammatory bowel disease: A report from the Epi-IIRN
Background and aims: The growing use of glucagon-like peptide 1 (GLP-1) analogs for type 2 diabetes mellitus (DM2) and obesity necessitates studies about their use in patients with inflammatory bowel diseases (IBD).
Methods: Data on patients with DM2 were retrieved from an Israeli nationwide cohort of patients with IBD (Epi-IIRN), recording GLP-1 analog exposure for at least 6 months. The primary outcome was poor disease outcomes (i.e., composite of steroid dependence, initiation of advanced IBD therapy, hospitalization, surgery, or death). Cox proportional hazard models with time-varying covariables were used to assess the impact of GLP-1 use on outcomes during follow-up.
Results: The authors included 3737 patients (24,338 patient-years) with IBD and DM2 (50.4% ulcerative colitis [UC]), of whom 633 were treated with GLP-1 analogs. Accounting for demographics IBD/DM2 related variables, medication use, and laboratory measurements, GLP-1 analog use was associated with reduced composite outcome in the full cohort (adjusted hazard ratio [aHR] = 0.74, 95% confidence interval [CI]: 0.62–0.89) and in each subtype (UC [aHR = 0.71, 95% CI: 0.52–0.96] and Crohn’s disease [aHR = 0.78, 95% CI: 0.62–0.99]). Similar trends were seen in multivariate analyses of each individual outcome, although only hospitalization was significant (aHR = 0.74, 95% CI: 0.61–0.91). The protective effect of GLP-1 analogs was seen in patients with obesity (aHR = 0.61, 95% CI: 0.50–0.77), but not in non-obese (aHR = 0.94, 95% CI: 0.67–1.31).
Conclusions: GLP-1 analogs are associated with improved outcomes in inflammatory bowel disease, specifically in patients with obesity. The mechanisms of these effects require further investigation as well as their role in patients without type 2 diabetes mellitus.