Gorelik Yuri, Ghersin Itai, Lujan Rona, Shlon Dima, Loewenberg Weisband Yiska, Ben-Tov Amir, Matz Eran, Zacay Galia, Dotan Iris, Turner Dan, Bar-Yoseph Haggai
Department of Internal Medicine D, Rambam Health Care Campus, Haifa, Israel.
Department of Internal Medicine H, Rambam Health Care Campus, Haifa, Israel.
J Crohns Colitis. 2025 Apr 4;19(4). doi: 10.1093/ecco-jcc/jjae160.
The growing use of glucagon-like peptide 1 (GLP-1) analogs for type 2 diabetes mellitus (DM2) and obesity necessitates studies about their use in patients with inflammatory bowel diseases (IBD).
Data on patients with DM2 were retrieved from an Israeli nationwide cohort of patients with IBD (epi-IIRN), recording GLP-1 analog exposure for at least 6 months. The primary outcome was poor disease outcomes (ie, composite of steroid dependence, initiation of advanced IBD therapy, hospitalization, surgery, or death). Cox proportional hazard models with time-varying covariables were used to assess the impact of GLP-1 use on outcomes during follow-up.
We included 3737 patients (24 338 patient-years) with IBD and DM2 [50.4% ulcerative colitis (UC)], of whom 633 were treated with GLP-1 analogs. Accounting for demographics IBD/DM2 related variables, medication use, and laboratory measurements, GLP-1 analog use was associated with reduced composite outcome in the full cohort (adjusted hazard ratio [aHR] 0.74, 95% confidence interval [CI] 0.62-0.89) and in each subtype [UC (aHR 0.71, 95% CI 0.52-0.96) and Crohn's disease (aHR 0.78, 95% CI 0.62-0.99)]. Similar trends were seen in multivariate analyses of each individual outcome, although only hospitalization was significant (aHR 0.74, 95% CI 0.61-0.91). The protective effect of GLP-1 analogs was seen in patients with obesity (aHR 0.61, 95% CI 0.50-0.77), but not in non-obese (aHR 0.94, 95% CI 0.67-1.31).
GLP-1 analogs are associated with improved outcomes in IBD, specifically in patients with obesity. The mechanisms of these effects require further investigation as well as their role in patients without DM2.
胰高血糖素样肽1（GLP-1）类似物在2型糖尿病（DM2）和肥胖症治疗中的应用日益广泛，因此有必要研究其在炎症性肠病（IBD）患者中的使用情况。
从以色列全国性IBD患者队列（epi-IIRN）中检索DM2患者的数据，记录GLP-1类似物暴露至少6个月的情况。主要结局为疾病不良结局（即类固醇依赖、开始使用晚期IBD治疗、住院、手术或死亡的综合情况）。使用具有时变协变量的Cox比例风险模型来评估GLP-1使用对随访期间结局的影响。
我们纳入了3737例IBD和DM2患者（24338患者年）[50.4%为溃疡性结肠炎（UC）]，其中633例接受了GLP-1类似物治疗。在考虑人口统计学、IBD/DM2相关变量、药物使用和实验室测量因素后，GLP-1类似物的使用与整个队列中综合结局的降低相关（调整后风险比[aHR]0.74，95%置信区间[CI]0.62-0.89），在每个亚型中也是如此[UC（aHR 0.71，95%CI 0.52-0.96）和克罗恩病（aHR 0.78，95%CI 0.62-0.99）]。在对每个个体结局的多变量分析中也观察到了类似趋势，尽管只有住院情况具有统计学意义（aHR 0.74，95%CI 0.61-0.91）。GLP-1类似物的保护作用在肥胖患者中可见（aHR 0.61，95%CI 0.50-0.77），但在非肥胖患者中未见（aHR 0.94，95%CI 0.67-1.31）。
GLP-1类似物与IBD结局改善相关，特别是在肥胖患者中。这些作用的机制以及它们在非DM2患者中的作用需要进一步研究。
