S1632 GLP-1 Receptor Agonists Are Associated With Reduced IBD Exacerbations, Hospitalizations, and ER Visits: A Multicenter Observational Cohort Study

Introduction: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are commonly prescribed for type 2 diabetes and obesity. These agents have demonstrated systemic anti-inflammatory effects and gut-modulating properties. Increasing evidence suggests that GLP-1 RAs may influence IBD activity through weight loss–mediated immune modulation, enhanced intestinal barrier function, and modified gut-brain signaling. However, their clinical impact on IBD exacerbations has not been well studied. Methods: Using the TriNetX research network, we conducted a retrospective cohort study of adults with Crohn’s disease or ulcerative colitis. Patients who initiated GLP-1 RA therapy after IBD diagnosis were matched 1:1 with non-GLP-1 users based on age, sex, BMI, IBD subtype, diabetes status, immunosuppressant use, and comorbidities (n = 16,717 per group). Outcomes assessed over 12 months included (1) IV corticosteroid use, (2) inpatient hospitalization, and (3) emergency department (ED) visits. Risk differences (RD), risk ratios (RR), and odds ratios (OR) were calculated with 95% confidence intervals (CI). Results: GLP-1 RA use was associated with significantly reduced risk across all measured outcomes. For IV corticosteroids, methylprednisolone was used in 16.5% of GLP-1 users vs 21.3% of non-users (RD −4.8%, RR 0.776, OR 0.731, P < 0.0001); hydrocortisone in 7.5% vs 10.7% (RD −3.2%, RR 0.702, OR 0.678, P < 0.0001); and dexamethasone in 15.0% vs 21.8% (RD −6.8%, RR 0.689, OR 0.634, P < 0.0001). Hospitalizations occurred in 15.5% of GLP-1 users vs 36.9% of controls (RD −21.5%, RR 0.419, OR 0.313, P < 0.0001). ED visits were also lower among GLP-1 users (23.5% vs 31.5%, RD −8.0%, RR 0.746, OR 0.667, P < 0.0001). Conclusion: In this large observational cohort, GLP-1 RA therapy was associated with significantly fewer IBD exacerbation markers, including steroid use, hospitalizations, and ED visits. These findings support a potential protective role of GLP-1 RAs in modifying IBD activity through metabolic and anti-inflammatory pathways. While limited by its retrospective design and potential unmeasured confounding, this study highlights a promising therapeutic intersection between obesity management and chronic gastrointestinal inflammation in a real-life clinical setting, warranting prospective evaluation.