S2338 GLP-1 Receptor Agonist Therapy in Obese Patients With Coexisting IBD and MASLD: Metabolic and Inflammatory Outcomes

Introduction: GLP-1 receptor agonists (GLP-1 RAs) are widely used for obesity and type 2 diabetes and have shown promise in improving hepatic outcomes in metabolic dysfunction-associated steatotic liver disease (MASLD). However, their safety and efficacy in patients with coexisting inflammatory bowel disease (IBD) remains underexplored. Given the overlap in metabolic and inflammatory pathways in MASLD and IBD, this study aimed to evaluate hepatic and intestinal outcomes associated with GLP-1 RA use in obese patients with both conditions. Methods: We conducted a retrospective cohort study using medical records from adult patients with confirmed IBD (Crohn’s disease or ulcerative colitis), coexisting MASLD, and BMI ≥30, seen at the outpatient department of Bahrain Government Hospitals between January 2022 and December 2024. Patients were categorized into 2 groups: those who received GLP-1 RAs for at least 6 months, and those who did not receive any pharmacologic weight loss therapy during the same period. Primary outcomes included changes in liver enzymes (alanine aminotransferase [ALT], AST) and Fibrosis-4 (FIB-4) score over 12 months. Secondary outcomes included IBD flare rate (defined by corticosteroid use, hospitalization, or therapy escalation), weight change, and gastrointestinal adverse events. Multivariate regression analysis was used to assess the association between GLP-1 RA use and outcomes while adjusting for age, sex, baseline ALT, diabetes, and IBD subtype. Results: A total of 124 patients were included, mean age 47.3 ± 8.1 years, 46% woman. GLP-1 RA use was associated with greater reductions in ALT (adjusted β −17.8 U/L, P = 0.003) and FIB-4 (adjusted β −0.22, P = 0.01), and greater weight loss (adjusted β −7.1%, P < 0.001). No significant difference in IBD flare rates was observed (22.6% vs 24.2%, adjusted OR 0.92, P = 0.81), and no serious GI adverse events were reported. Subgroup analysis of Crohn’s patients showed lower flare rates with GLP-1 RA use (21.6% vs 29.2%), though not statistically significant (P = 0.38). Conclusion: In this retrospective cohort of obese patients with coexisting IBD and MASLD, GLP-1 receptor agonist therapy was associated with improved hepatic biomarkers and significant weight loss without increasing the risk of IBD flare. These findings suggest that GLP-1 RAs may be a safe and effective option in this complex patient population and support further prospective research to validate their role in IBD-MASLD overlap.