S1990 Effect of Dual GLP-1/GIP and GLP-1 Agonists on Inflammatory Bowel Disease Activity Among Patients With Obesity

Introduction: Inflammatory bowel disease (IBD), either Crohn’s disease (CD) or ulcerative colitis (UC), is an autoimmune condition characterized by inflammation of GI tract. Obesity is a risk factor for IBD activity. Mounting evidence shows injectable incretins such as Glucagon-like peptide 1 (GLP-1) agonists cause weight loss and may improve IBD disease activity. Newer GLP-1 based agents like tirzepatide, which is a dual agonist of both GLP-1 and Glucose-dependent Insulinotropic Polypeptide (GIP), may have superior weight loss, but their effect on IBD is not known. In this study, we aimed to assess outcomes in patients with IBD and obesity with various GLP-1 medication use vs non-use. Methods: A retrospective, propensity-matched analysis using data from The OneFlorida+ network from 2012-2023 was done. We evaluated patients with IBD and obesity prescribed GLP-1 based therapy (liraglutide, semaglutide, or tirzepatide) vs those without. 562 patients prescribed GLP-1 based therapies were matched 1:1 to controls based on age, sex, race, BMI, and comorbidities (n = 1,124). The control group was time-matched based on GLP-1 users’ index prescription date and all patients were assessed at 12 months. The Cox proportional hazard model was used for analysis. Results: No differences in GLP-1 users vs non-users with respect to all-cause hospitalization (HR 1.04, CI 0.85-1.28), IBD-hospitalization (HR 1.30, CI 0.90–1.88), IBD-related surgery (HR 0.49, CI 0.21–1.17), or pancreatitis (HR 0.74, CI 0.37-1.47) were seen. In the subgroup analysis, black GLP-1 users had an increased risk of all-cause hospitalizations (HR 1.59, CI 1.11–2.29) but not IBD-related hospitalization (HR 1.41, CI 0.78–2.56) or IBD-related surgery (HR 0.67, CI 0.14-3.13). Use of semaglutide reduced the risk of IBD-related surgery (HR 0.33, CI 0.13-0.83). Among 89 tirzepatide users, none required IBD related surgery vs 2 among matched controls, but this was not statistically significant. Rates of steroid use were low between groups. Conclusion: Semaglutide use appeared to lower the risk of IBD-related surgery. Black patients using GLP-1 therapy had an increased risk of all-cause hospitalization, but not IBD-related hospitalization or surgery. Tirzepatide was not associated with net harms or benefits in the studied end points however there were few patients on this medicine. Overall, GLP-1 based therapies were well tolerated in this patient population. Further investigation with larger studies is warranted.