P4372 - Risk of Inflammatory Bowel Disease Complications in Obese Inflammatory Bowel Disease Patients on GLP-1 Therapy: A Large Multicenter Cohort Study

Ayowumi A.. Adekolu, MD¹, Ethan M. Cohen, MD¹, Taylor McCready, MPH², Olanrewaju Adeniran, MBBS¹, Justin T.. Kupec, MD^1
1West Virginia University, Morgantown, WV; ²NYU Grossman School of Medicine, New York, NY

Introduction: The prevalence of obesity in adults with inflammatory bowel disease (IBD), which includes ulcerative colitis (UC) and Crohn's disease (CD), ranges from 15-40%. Obesity itself causes a state of chronic inflammation, which has been shown to be associated with poorer disease outcomes. Glucagon-like peptide-1 analogs (GLP-1) are approved for use in obesity and diabetes and have recently been shown to reduce intestinal and systemic inflammation. However, there are limited studies assessing its effect in patients with IBD. We aim to evaluate the risk of IBD complications (bleeding, abscess, fistula, and intestinal obstruction) in obese patients with IBD who are on GLP-1 therapy.

Methods: We conducted a population-based, nationwide retrospective cohort study using the TriNetX platform. Adult patients ≥18 years old with a diagnosis of IBD and obesity (BMI ≥ 30) were included. In the intervention cohort, participants were included if they were on a GLP-1 analog (semaglutide, liraglutide and tirzepatide) after diagnosis of IBD and obesity. We excluded patients with a previous history of IBD complications prior to the use of GLP-1 and up to 1 month after initiation of GLP-1 therapy. Patients diagnosed with IBD and obesity who were on GLP-1 were matched with patients diagnosed with IBD and obesity not on GLP-1 analogs using a 1:1 propensity score match (PSM) according to demographics, long term NSAID use, and nicotine use.

Results: Before PSM, the intervention cohort who were obese with IBD and were on GLP-1 comprised 122,617 patients, while the control cohort that were not on GLP-1 totaled 7,424 patients. 7,420 patients were matched. Given that all PSM assumptions hold, the risk for IBD complication was significantly increased in the control cohort (RR 8.65; 95% CI 7.23, 10.35) compared to the intervention cohort (Table 1).

Discussion: In this large cohort study, we found that the risk of IBD complications was higher in obese IBD patients not on GLP-1 when compared to the intervention cohort. While the pathophysiology of the GLP-1 effect in IBD has not been fully elucidated, previous studies have theorized that GLP-1 may promote tissue repair of injured epithelium, regulate innate immune cells and dendritic cells, regulate T-cell differentiation and functions, and reduce proinflammatory cytokines in IBD. While our study shows that GLP-1s may be beneficial in obese IBD patients on GLP-1 therapy, further studies are needed to validate this effect of GLP-1s.


Disclosures:


Ayowumi A.. Adekolu, MD¹, Ethan M. Cohen, MD¹, Taylor McCready, MPH², Olanrewaju Adeniran, MBBS¹, Justin T.. Kupec, MD¹. P4372 - Risk of Inflammatory Bowel Disease Complications in Obese Inflammatory Bowel Disease Patients on GLP-1 Therapy: A Large Multicenter Cohort Study, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.