P2348 - Factors Relating to Slow Gastric Emptying on Glucagon-Like Peptide-1 Agonist Therapy, Lack of Prolonged Emptying Slowing After GLP1 Agonist Cessation, and Impact of Emptying Delays on GLP1 Agonist Prescription Patterns
William L. Hasler, MD1, Rosita Frazier, MD2, Tisha N. Lunsford, MD2, Bridget Cervantes, PA1, Ming Yang, MD1, Lucinda Harris, MD1 1Mayo Clinic Arizona, Scottsdale, AZ; 2Mayo Clinic, Scottsdale, AZ
Introduction: Contributions of clinical and pharmacokinetic factors to glucagon-like peptide-1 receptor agonist (GLP1 RA)-induced slowing of gastric emptying are uncertain. It is unknown if slowed emptying persists long-term after stopping GLP1 RAs or if emptying results inform subsequent prescription of GLP1 RAs. We tested if: (i) gastric emptying is slowed by GLP1 RAs only in women and with long half-life GLP1 RAs, (ii) slowing of emptying is similar when used for obesity vs. diabetes, (iii) slowed emptying resolves quickly after GLP1 RA cessation, and (iii) GLP1 RAs are rarely prescribed de novo after documenting delays.
Methods: Records of GLP1 RA prescriptions for patients undergoing gastric scintigraphy from 1/2023-4/2024 were searched using the terms GLP, semaglutide, tirzepatide, dulaglutide, and liraglutide. Patients were stratified into those on vs. not on GLP1 RAs at the time of scintigraphy. The latter group included those who stopped agents >5 drug half-lives before testing and those who began GLP1 RAs after scintigraphy. Emptying was quantified 4 hr after 99Tc-labelled egg meals.
Results: 85/756 patients (11%) undergoing scintigraphy were treated with GLP1 RAs, which were taken during scintigraphy by 34, stopped >5 half-lives before testing by 27, and started after scintigraphy by 24 patients. Gastric emptying was not slowed on GLP1 RAs in the whole group (Fig 1A) but was slowed selectively in women on these meds (P=0.02). In women, emptying was similarly slowed on GLP1 RAs given for obesity vs. diabetes (Fig 1B). Also in women, long half-life ( >5 days) GLP1 RAs (semaglutide, tirzepatide) but not short acting (< 4 days) agents (liraglutide, dulaglutide) were associated with slowed emptying (P=0.02). Emptying was not different in those who stopped GLP1 RAs for < 3 vs. >3 months before scintigraphy (90+11 vs. 89+13%, P=0.90). 4/24 patients (17%) without initial use who were prescribed GLP1 RAs after scintigraphy showed emptying delay.
Discussion: GLP1 agonist use is prevalent in patients undergoing gastric emptying testing. Slowing of emptying on GLP1 RAs was seen only in women, especially on long half-life agents, but was no different when used for obesity vs. diabetes. Emptying was similar after stopping GLP1 RAs < 3 months vs. >3 months before scintigraphy, showing that prolonged gastric motor impairment is rare. Few patients with emptying delays were begun de novo on GLP1 RAs, perhaps reflecting the impact of scintigraphy to inform therapy.
Figure: Relations of gastric emptying on and not on GLP1 RA to clinical factors and drug half-life are shown. Slowing of gastric emptying did not reach significance in the whole group but emptying on GLP1 RA was slower in women (Fig 1A). Slowing of gastric emptying showed similar trends for patients started on GLP1 RA for obesity vs. diabetes (Fig 1B). Slowing of emptying was significantly greater only for GLP1 RA with long half-lives.
Disclosures:
William Hasler: ATMO Biosciences – Grant/Research Support. Enterra Medical – Advisor or Review Panel Member. Evoke Pharma – Speakers Bureau.
Rosita Frazier indicated no relevant financial relationships.
Tisha Lunsford indicated no relevant financial relationships.
Bridget Cervantes indicated no relevant financial relationships.
Ming Yang indicated no relevant financial relationships.
Lucinda Harris indicated no relevant financial relationships.
William L. Hasler, MD1, Rosita Frazier, MD2, Tisha N. Lunsford, MD2, Bridget Cervantes, PA1, Ming Yang, MD1, Lucinda Harris, MD1. P2348 - Factors Relating to Slow Gastric Emptying on Glucagon-Like Peptide-1 Agonist Therapy, Lack of Prolonged Emptying Slowing After GLP1 Agonist Cessation, and Impact of Emptying Delays on GLP1 Agonist Prescription Patterns, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
