Glucagon-like peptide 1 receptor agonists and the clinical outcomes of inflammatory bowel disease: a systematic review and meta-analysis

Ahmed B Bayoumy; Lindsay M Clarke; Parakkal Deepak; Aakash Desai; Priya Sehgal; Uri Gorelik; Haggai Bar-Yoseph; Marie Villumsen; Chris J J Mulder; Dirk J Stenvers; Maarten E Tushuizen; Nanne K H de Boer

doi:10.1093/ecco-jcc/jjaf181

Glucagon-like peptide 1 receptor agonists and the clinical outcomes of inflammatory bowel disease: a systematic review and meta-analysis

J Crohns Colitis. 2025 Nov 8;19(10):jjaf181. doi: 10.1093/ecco-jcc/jjaf181.

Authors

Ahmed B Bayoumy^{1

2}, Lindsay M Clarke³, Parakkal Deepak⁴, Aakash Desai⁵, Priya Sehgal⁶, Uri Gorelik⁷, Haggai Bar-Yoseph^{8

9}, Marie Villumsen¹⁰, Chris J J Mulder^{1

2}, Dirk J Stenvers^{2

11}, Maarten E Tushuizen¹², Nanne K H de Boer^{1

2}

Affiliations

¹ Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, The Netherlands.
² Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam, The Netherlands.
³ Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States.
⁴ Division of Gastroenterology and Inflammatory Bowel Diseases Center, Washington University in Saint Louis School of Medicine, St Louis, MI, United States.
⁵ Division of Gastroenterology, Hepatology, and Nutrition, Allegheny Health Network, Pittsburgh, PA, United States.
⁶ Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, United States.
⁷ Department of Internal Medicine, Rambam Health Care Campus, Haifa, Israel.
⁸ Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel.
⁹ The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel institute of technology, Haifa, Israel.
¹⁰ Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark.
¹¹ Department of Endocrinology and Metabolism, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
¹² Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands.

Abstract

Background: Prior studies showed worse outcomes in obese inflammatory bowel disease (IBD) patients, especially those related to hospitalizations, surgery, and steroid-free remission. Glucagon-like peptide-1 receptor agonists (GLP1-RAs) have demonstrated significant metabolic benefits for patients with type 2 diabetes mellitus (T2DM) and obesity. Hence, GLP1-RAs may improve clinical outcomes in patients with IBD, especially those with obesity. The objective was to systematically evaluate the impact of GLP1-RAs on clinical outcomes in patients with IBD.

Methods: A comprehensive literature search was performed using the databases PubMed, Embase, Web of Science, and Cochrane Library from inception to March 15, 2025. Studies reporting outcomes related to GLP1-RAs in patients with IBD were included. Primary outcomes included weight loss and various IBD-related co-endpoints such as hospitalizations, surgery, corticosteroid use, and advanced therapy initiation.

Findings: In total, 11 studies with 16 242 patients with IBD treated with GLP1-RAs were included. Weight loss was achieved using semaglutide (-9.6 kg, 95% confidence interval [CI]: -12.0; -7.2), liraglutide (-9.4 kg, 95% CI: -13.0; -5.8), and tirzepatide (-11.8 kg, 95% CI: -18.3; -5.4) after 3 months of follow-up. In meta-analyses, GLP1-RAs were associated with lower risk of surgery for effect sizes (logHR: 0.61 [95% CI: 0.44-0.84], I 2 = 0%) and event frequencies (odds ratio [OR]: 0.46 [95% CI: 0.32-0.67], I 2 = 42%). Sensitivity analysis for body mass index (BMI) showed a lower risk of hospitalizations and surgery in patients with obesity (BMI ≥ 30).

Interpretation: Patients with IBD and obesity using GLP1-RAs were able to achieve significant weight loss and had lower risks of surgery and hospitalizations. Our findings require confirmation in prospective trials of GLP1-RAs in IBD.

Keywords: Crohn’s disease; GLP1-RA; corticosteroid use; drug repurposing; hospitalization; inflammatory bowel disease; meta-analysis; obesity; systematic review; type 2 diabetes mellitus; ulcerative colitis.

Publication types

Systematic Review
Meta-Analysis

MeSH terms

Glucagon-Like Peptide 1
Glucagon-Like Peptide-1 Receptor Agonists*
Glucagon-Like Peptides / therapeutic use
Hospitalization / statistics & numerical data
Humans
Inflammatory Bowel Diseases* / complications
Inflammatory Bowel Diseases* / drug therapy
Liraglutide / therapeutic use
Obesity* / complications
Obesity* / drug therapy
Semaglutide
Treatment Outcome
Weight Loss / drug effects

Substances

Glucagon-Like Peptide-1 Receptor Agonists
Liraglutide
Glucagon-Like Peptides
Glucagon-Like Peptide 1
Semaglutide