Glucagon-like peptide 1 receptor agonists and the clinical outcomes of inflammatory bowel disease: A Systematic Review and Meta-analysis

BACKGROUND: Prior studies showed worse outcomes in obese inflammatory bowel disease (IBD) patients, especially those related to hospitalizations, surgery and steroid-free remission. Glucagon-like peptide-1 receptor agonists (GLP1-RAs) have demonstrated significant metabolic benefits for patients with type 2 diabetes mellitus (T2DM) and obesity. Hence, GLP1-RAs may improve clinical outcomes in patients with IBD, especially those with obesity. The objective was to systematically evaluate the impact of GLP1-RAs on clinical outcomes in patients with IBD.

METHODS: A comprehensive literature search was performed using the databases PubMed, Embase, Web of Science, and Cochrane Library from inception to 15-03-2025. Studies reporting outcomes related to GLP1-RAs in patients with IBD were included. Primary outcomes included weight loss and various IBD-related co-endpoints such as hospitalizations, surgery, corticosteroid use, and advanced therapy initiation.

FINDINGS: In total, 11 studies with 16,242 patients with IBD treated with GLP1-RAs were included. Weight loss was achieved using semaglutide (-9.6 kg, CI-95% -12.0; -7.2), liraglutide (-9.4 kg, CI-95% -13.0; -5.8) and tirzepatide (-11.8 kg, CI-95% -18.3; -5.4) after 3 months of follow-up. In meta-analyses, GLP1-RAs were associated with lower risk of surgery for effect sizes (logHR: 0.61 [95%-CI 0.44-0.84], I2 = 0%) and event frequencies (OR: 0.46 [95%-CI 0.32-0.67], I2 = 42%). Sensitivity analysis for BMI showed lower risk of hospitalizations and surgery in patients with obesity (BMI≥30).

INTERPRETATION: Patients with IBD and obesity using GLP1-RAs were able to achieve significant weight loss and had lower risks of surgery and hospitalizations. Our findings require confirmation in prospective trials of GLP1-RAs in IBD.