Assessing the Impact of GLP-1R Agonists in Post-sinus Surgery Management

Abstract

Objective: Emerging evidence suggests a potential association between chronic rhinosinusitis (CRS) and obesity. With the increasing utilization of weight loss medications in the management of obesity, we aimed to assess the impact of glucagon-like peptide-1 receptor agonist (GLP-1RA) prescription on the revision rate of functional endoscopic sinus surgery (FESS) and the use of biologics post-FESS.

Study design: Retrospective cohort analysis.

Setting: US Collaborative Network within the TriNetX Analytics platform.

Methods: We queried the TriNetX Analytics platform for all adult CRS with nasal polyps (CRSwNP) patients with obesity who have undergone at least one prior FESS (based on Current Procedural Terminology [CPT] code). The incidence of revision surgery and first-time biologic prescriptions (dupilumab, mepolizumab, and omalizumab) within a 1- and 5-year follow-up period was assessed, comparing those with and without GLP-1R agonist prescriptions.

Results: After 1:1 propensity matching, there were a total of 1391 patients in each patient group. The GLP-1RA cohort had a significantly reduced incidence of revision FESS compared to the non-GLP-1RA cohort at 1-year (RR: 0.64; 95% CI: 0.41-0.98, P = .04) and 5-year follow-up periods (risk ratio [RR]: 0.60; 95% CI: 0.44-0.0.81, P = .001). At the 5-year follow-up, the first-time biologic prescription was lower in the GLP-1RA cohort compared to the non-GLP-1RA cohort (RR: 0.72; 95% CI: 0.52-0.98, P = .04).

Conclusion: Our results indicate that GLP-1RAs are associated with reduced postoperative revision FESS at up to a 5-year follow-up in CRSwNP patients. Future mechanistic and prospective studies are needed to confirm the association between GLP-1R agonists and improved post-sinus surgery outcomes identified in this study.

Keywords: GLP‐1RA; TriNetX; chronic rhinosinusitis; obesity.