S2002 Association of Body Mass Index and GLP-1 in Outcomes in Inflammatory Bowel Disease

Introduction: Glucagon-like peptide-1 (GLP-1) receptor agonists are commonly prescribed for diabetes and obesity, 2 prevalent comorbidities in individuals with inflammatory bowel disease (IBD). However, data on their safety and impact on IBD-related complications remain limited. This study evaluates the association between GLP-1 agonist use and the incidence of IBD complications in lean and non-lean patients. Methods: Utilizing the TriNetX research database, which includes data across 148 healthcare organization, this study uses International Classification of Diseases-10 codes to identify lean patients (body mass index ≤24.9) (CD w/GLP: 1,180; CD w/o GLP: 142,106; UC w/GLP: 1,402; UC w/o GLP: 143,250) and non-lean (BMI ≥25) (CD w/GLP: 5,257; CD w/o GLP: 171,076; UC w/GLP: 7,016; UC w/o GLP: 196,480) with a diagnosis of Crohn’s disease (CD) or Ulcerative Colitis (UC) which was then divided by the presence of a GLP-1 agonist. A propensity score matching (PSM) system and cox proportional hazards model was used to determine if the presence of a GLP-1 agonist affected the incidence of anal fissure, anal fistula, intestinal abscess, intestinal obstruction (IO), gastrointestinal bleeds (GIB), certain extraintestinal manifestations (EIM), perforation, megacolon, hospitalization and mortality within a 5-year period. Results: In lean CD patients, GLP-1 use was associated with a statistically significant reduction of complications including IO, GIB, hospitalization, and mortality (P < 0.05). In non-lean CD patients, GLP-1 use similarly correlated with a statistically significant reduction of complications including IO, hospitalization, and mortality (P < 0.05). In lean UC patients, GLP-1 use was associated with a statistically significant decreased risk of GIB, hospitalization, and mortality (P < 0.05). In non-lean UC patients, GLP-1 use was associated with a statistically significant reduction of complications, including intestinal abscess, anal fistula, GIB, perforation, hospitalization, and mortality (P < 0.05). Although osteoarthritis and anal fistula resulted in P-values < 0.05 in CD patients, the confidence intervals did not suggest a statistically significant effect of GLP-1 use. Lastly, no differences were observed in the incidence of EIMs or megacolon. Conclusion: GLP-1 agonist use was associated with reduced rates of select IBD complications and mortality in both lean and non-lean IBD patients. While the protective mechanism remains unclear, these findings highlight the need for prospective studies to explore GLP-1’s therapeutic role in IBD management.