Glucagon-Like Peptide-1 Receptor Agonist Therapy Does Not Increase Gastrointestinal Adverse Events in Patients with Inflammatory Bowel Disease.

BACKGROUND

As the prevalence of obesity rises among patients with inflammatory bowel disease (IBD), concerns have emerged regarding the gastrointestinal safety of glucagon-like peptide-1 receptor agonists (GLP-1 RAs), which are increasingly used for diabetes and weight management.

METHODS

We conducted a retrospective cohort study of adult patients with IBD on GLP-1 RA therapy within a large academic medical system between 2010 and 2024. We compared gastrointestinal adverse events-including ileus or bowel obstruction, bowel surgery, IBD-related hospitalization, and escalation of medical therapy-occurring in the one-year period preceding and following GLP-1 RA exposure, which was defined by at least two prescriptions within 90 days.

RESULTS

Among 271 patients (median age 62.8 years; 62% female; 64% ulcerative colitis), 80 completed 12 months and an additional 168 completed 6 months of GLP-1 RA therapy. Semaglutide was the most common agent (58%), followed by dulaglutide (28%), tirzepatide (14%), and liraglutide (1%). No significant difference in gastrointestinal adverse event rates was observed between pre- and post-treatment intervals when normalized for exposure time (p ≥ 0.10 for all comparable adverse events). Median BMI declined modestly from 33.8 to 33.4 kg/m at 12 months (p = 0.20). Subgroup analyses by agent, sex, IBD type, and GLP-1 RA indication yielded similar findings.

CONCLUSIONS

GLP-1 RA therapy does not increase gastrointestinal adverse events in patients with IBD over 12 months, supporting its safety in this population.