February 2024
Gastrointestinal adverse events in patients taking GLP-1 agonists for weight loss

These agents were associated with small excess risks for pancreatitis, bowel obstruction and gastroparesis.

When used to manage diabetes, glucagon-like peptide-1 (GLP-1) agonists confer excess risk for adverse gastrointestinal (GI) events, including pancreatitis, biliary disease, bowel obstruction and gastroparesis. In this study, researchers looked at risk for adverse GI events in 4800 patients who used liraglutide and semaglutide for weight loss (i.e. who had a diagnosis of obesity without a diagnosis of diabetes in a US national health claims database). This cohort was compared with 650 patients who also had diagnosis codes for obesity but not diabetes and who used bupropion-naltrexone for weight loss.

During median follow up of about one year, adjusted hazard ratios for pancreatitis, bowel obstruction and gastroparesis were all significantly higher among patients who used GLP-1 agonists than among those who used bupropion-naltrexone (9.1, 4.2 and 3.7, respectively); biliary disease was similar in both cohorts. Among the nearly 90% of GLP-1 patients who were receiving liraglutide, excess incidence of pancreatitis and bowel obstruction were about seven per 1000 patient-years and six per 1000 patient- years, respectively.

Comment: Patients often note nausea and vomiting as side effects of GLP-1 agonists, presumably due to delayed gastric emptying. This study should raise awareness among clinicians that GLP-1 agonists, whether taken for diabetes or weight loss, occasionally are associated with more serious adverse GI events.

Thomas L. Schwenk, MD, Professor Emeritus, Family and Community Medicine, University of Nevada School of Medicine, Reno, USA.

Sodhi M, et al. Risk of gastrointestinal adverse events associated with glucagon-like peptide-1 receptor agonists for weight loss. JAMA 2023; 330: 1795-1797.

This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine, Hospital Medicine, Gastroenterology.