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

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 16242 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.