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Key takeaways:
GLP-1s plus lifestyle counseling sustained weight loss and improved bowel symptoms in patients with IBD with obesity.
Fatigue also improved without IBD-related hospitalizations or changes in therapy.
CHICAGO — Patients with obesity and inflammatory bowel disease showed improved bowel function while receiving GLP-1 receptor agonists and lifestyle counseling, in contrast to the gastrointestinal issues typically associated with GLP-1s.
“Given that gastrointestinal side effects are often a concern with GLP-1 therapy, it was notable that patients reported improvement rather than worsening of bowel symptoms, suggesting these therapies may have broader benefits in selected patients with IBD,” Stephanie Lauren Gold, MD,assistant professor of gastroenterology at Icahn School of Medicine at Mount Sinai, told Healio.
Gold and colleagues presented their research at Digestive Disease Week.
“These findings highlight the importance of integrating metabolic and weight management interventions into routine IBD care,” Gold continued.
The treatment combination also was associated with clinically significant weight loss and reduced patient-reported fatigue.
Obesity may be a modifiable risk factor in patients with IBD, the researchers wrote.
“In the general population, GLP-1s are well-established therapeutic options to treat obesity,” Gold said. “However, prospective and real-world data on the safety and efficacy of GLP-1 therapy in patients with IBD remain limited.”
For a 12-month period, 95 patients (median age, 40 years; 64% women; median BMI, 35 kg/m2) with an IBD diagnosis and a BMI higher than 25 kg/m2 received guidance on diet and exercise at a multidisciplinary IBD-metabolic clinic. Vibration controlled transient elastography showed 68 patients had hepatic steatosis and three had fibrosis.
Clinicians initiated GLP-1 therapy among 50 patients who met indication criteria — BMI of at least 27 kg/m2 with a comorbidity or BMI of at least 30 kg/ m2 — and could pay for or had insurance to cover the drug.
Data on IBD symptoms, weight loss and fatigue were gathered at baseline and 3, 6, 9 and 12 months of follow-up.
During the study period, patients receiving both GLP-1 therapy and lifestyle counseling had a significantly greater median percent weight change than those treated with counseling alone. At 3 months, the difference was –5.5% vs. +1%; 6 months, –9.5% vs. +2%; 9 months, –13.8% vs. +1%; and 12 months, –20.9% vs. +3%.
Patients receiving the combined intervention also reported reduction in fatigue and improvement in stool frequency and consistency after 3 months.
The researchers observed no significant differences in ED visits, hospitalizations and changes in IBD therapy between cohorts.
Further research is required on the topic, according to Gold and colleagues.
“We need prospective studies to define optimal dosing, duration, long-term safety, predictors of response and tolerability, and whether GLP-1 therapy can improve IBD-related outcomes beyond weight loss,” Gold said. “It is also important to focus on a more personalized approach for obesity care in patients with IBD, identifying which patients are most likely to benefit from specific interventions.”
