Division of Gastroenterology and Hepatology, First Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece.
Basic and Translational Research Unit, Special Unit for Biomedical Research and Education, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636, Thessaloniki, Greece.
Curr Obes Rep. 2023 Jun;12(2):61-74. doi: 10.1007/s13679-023-00506-3. Epub 2023 Apr 21.
To discuss current literature and provide practical recommendations for the safe and effective use of glucagon-like peptide 1 receptor agonists (GLP-1 RA) in people with inflammatory bowel disease (IBD) and type 2 diabetes (T2D) and/or obesity. The molecular mechanisms that justify the potential benefits of GLP-1 RA in IBD and the links between IBD, obesity, and cardiovascular disease are also discussed.
Preliminary data suggest that GLP-1 RA can modulate crucial pathways in the pathogenesis of IBD, such as chronic inflammation circuits, intestinal tight junctions, and gut microbiome dysbiosis, setting the stage for human trials to investigate the role of these agents in the treatment of IBD among people with or without diabetes and obesity. However, gastrointestinal side effects related to GLP-1 RA need appropriate clinical management to mitigate risks and maximize the benefits of therapy in people with IBD. GLP-1 RA originally emerged as drugs for the treatment of hyperglycemia and are currently licensed for the management of T2D and/or overweight/obesity. However, their wealth of pleiotropic actions soon raised expectations that they might confer benefits on non-metabolic disorders. Future studies are expected to clarify whether GLP-1 RA deserve an adjunct place in the arsenal of drugs against IBD.
讨论目前关于胰高血糖素样肽 1 受体激动剂(GLP-1 RA)在炎症性肠病(IBD)、2 型糖尿病(T2D)和/或肥胖患者中的安全有效应用的文献,并提供实用建议。本文还讨论了 GLP-1 RA 在 IBD 中发挥潜在益处的分子机制,以及 IBD、肥胖和心血管疾病之间的联系。
初步数据表明,GLP-1 RA 可能调节 IBD 发病机制中的关键途径,如慢性炎症回路、肠道紧密连接和肠道微生物失调,为研究这些药物在糖尿病和非糖尿病肥胖患者中治疗 IBD 的作用的临床试验奠定了基础。然而,与 GLP-1 RA 相关的胃肠道副作用需要进行适当的临床管理,以降低风险并最大限度地提高 IBD 患者治疗的获益。GLP-1 RA 最初作为治疗高血糖的药物出现,目前被批准用于治疗 T2D 和/或超重/肥胖。然而,它们丰富的多效性作用很快引发了人们的期望,即它们可能对非代谢疾病有益。未来的研究有望阐明 GLP-1 RA 是否值得在治疗 IBD 的药物中占据一席之地。