P4304 - Safety and Effectiveness of Glucagon-Like Peptide 1 Receptor Agonists for Obesity in Patients With Inflammatory Bowel Disease

Lindsay Clarke, MD¹, Ravi Teja Pasam, MBBS, MPH², Pichamol Jirapinyo, MD, MPH³, Jessica R. Allegretti, MD, MPH, FACG⁴, Colleen R. Kelly, MD, FACG^5
1Brigham and Women's Hospital, Harvard Medical School, Boston, MA; ²Mass General Brigham, Boston, MA; ³Brigham and Women's Hospital, Boston, MA; ⁴Brigham and Women’s Hospital, Harvard Medical School, Boston, MA; ⁵Brigham and Women's Hospital, Harvard Medical School, Boston, MA

Introduction: Obesity is common in inflammatory bowel disease (IBD) and has a negative impact on disease outcomes. Glucagon-like peptide 1 receptor agonists (GLP-1 RA) have revolutionized obesity management, though GI effects are common. There is little data on use in patients with IBD, though studies suggest beneficial impact on barrier function, inflammation, and the microbiome. We aimed to determine the safety, effectiveness, and impact on IBD disease activity of GLP-1 RA in patients with IBD.

Methods: This is a retrospective cohort study of adults with obesity (BMI ≥30) and IBD treated with GLP-1 RA between 01/01/2020 and 12/31/2023 at an academic medical center. The primary outcome was effectiveness of GLP-1, defined by weight loss of ≥5% baseline body weight at 12-months post GLP-1RA initiation. IBD flare was defined as a composite outcome (IBD-related ED visits or hospitalizations, surgeries, escalation/change of IBD-directed therapy or steroid use) and compared between the 12-months pre- and post-GLP-1 RA. Safety outcomes were calculated in all patients who took GLP-1 RA for any duration. Patients without weight recorded post GLP-1 RA were excluded from primary analysis. Statistical analysis was performed using a paired t-test for continuous outcomes, and McNemar’s chi squared test for dichotomous outcomes. Logistic regression was performed for the primary outcome and adjusted for age, gender, baseline BMI, IBD diagnosis, and prior bariatric surgery.

Results: A total of169 patients were included (Table 1). Of 102 patients on GLP-1 RA for at least 12 months, 66 (64.7%) achieved ³5% and 47 (46.1%) achieved ³10% weight loss, with a mean decrease in BMI was 5.20 (95% CI 4.49, 5.92, P< 0.001) and mean change in body weight of 13.97kg (95% CI 12.32, 15.62, P< 0.001). Males had lower odds of achieving the primary outcome (OR 0.25, 95% CI 0.10, 0.62, P=0.003), with no difference in the other covariates. Of the 68 (40.2%) patients with treatment related AEs, 60 (88.2%) were GI, most commonly nausea/vomiting (35, 58.3%). GLP-1 RA were stopped in 48 (28.4%) of patients; 22 (45.8%) for AE/tolerability and 11 (22.9%) for drug access/cost. There was no difference in IBD flares observed within the 12 months preceding GLP-1 RA therapy (20, 19.6%) vs the 12 months after (16, 15.7%), (P=0.54).

Discussion: This study supports the safety, tolerability, and effectiveness of GLP-1RA for treatment of obesity in patients with IBD. Prospective clinical trials are needed given the potential for benefit in both diseases.


Disclosures:


Lindsay Clarke, MD¹, Ravi Teja Pasam, MBBS, MPH², Pichamol Jirapinyo, MD, MPH³, Jessica R. Allegretti, MD, MPH, FACG⁴, Colleen R. Kelly, MD, FACG⁵. P4304 - Safety and Effectiveness of Glucagon-Like Peptide 1 Receptor Agonists for Obesity in Patients With Inflammatory Bowel Disease, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.