Patients with asthma, obesity experience improved control with GLP-1 RAs
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Key takeaways:
- Patients had high-risk asthma and a BMI over 30 kg/m2.
- Patients who used GLP-1 RAs were 2.1 times more likely to achieve asthma control.
- Further work is needed to assess outcomes based on asthma phenotype.
Patients with asthma who used a glucagon-like peptide 1 receptor agonist for weight loss experienced improved asthma control, according to a poster presented at the European Respiratory Society International Congress.
“Obesity is known to be a risk factor for asthma and to be associated with poor asthma control,” Heath Heatley, PhD, senior researcher at Observational and Pragmatic Research Institute, said during his presentation.
Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) are recommended for treating obesity in the U.K., Heatley continued.
“To quantify the impact of GLP-1s on asthma control, we analyzed cohorts of people with obesity and high-risk asthma using the Optimum Patient Care Research Database,” he said.
The study included adults with active asthma and a BMI over 30 kg/m2, including 10,111 (mean age at index, 55.6 years; 35% men) who had received a GLP-1 RA prescription in the previous year and 50,555 (mean age at index, 55.4 years; 35% men) who had not.
“We also matched people on age, sex, exacerbation rate and prescriptions of short-acting beta agonists,” Heatley said.
The GLP-1 RA group included 2,724 (27%) patients with a BMI between 30 kg/m2 and 34.9 kg/m2, 3,033 (30%) with a BMI between 35 kg/m2 and 39.9 kg/m2 and 4,354 (43%) with a BMI of 40 kg/m2 and above.
The control group included 29,222 (58%) with a BMI between 30 kg/m2 and 34.9 kg/m2, 12,523 (25%) with a BMI between 35 kg/m2 and 39.9 kg/m2 and 8,810 (17%) with a BMI of 40 kg/m2 and above.
The GLP-1 RA group lost more weight during the first year of follow-up, with 6,218 (61%) losing a mean of 3.5 kg, than the control group, with 12,684 (25%) losing a mean of 0.9 kg.
Asthma assessments included Risk Domain Asthma Control (RDAC), which defined control as a lack of recorded exacerbations, unplanned hospital attendances, and antibiotics for lower respiratory illnesses in the previous 12 months, as well as Overall Asthma Control (OAC), which defined control as a positive RDAC score and fewer than three short-acting beta agonist prescriptions.
“These have been validated in previous studies,” Heatley said.
At baseline, percentages of patients with uncontrolled asthma based on RDAC included 38.6% of the GLP-1 RA group and 40.3% of the control group. Similarly, percentages of patients with uncontrolled asthma based on OAC included 67.5% of the GLP-1 RA group and 69.3% of the control group.
“Logistic regression analysis demonstrated higher levels of asthma control in both measures of asthma control, the RDAC and OAC, for people receiving GLP-1s, with an adjusted odds ratio of 2.1 for both measures,” Heatley said.
Based on these findings, the researchers concluded there were associations between GLP-1 RAs and both increased weight loss and improved asthma control among patients with high-risk asthma and obesity.
“The strength of our study comes from its real-world nature and its ability to quantify the wider benefits of weight reduction treatments, which is not easily done in a clinical trial,” Heatley said.
However, Price also said the study’s weaknesses related to its collection of follow-up data pertaining to weight, including a sizable amount of missing data and the potential for bias if patients did not feel like they were losing weight and did not attend re-measurements.
“Although designed predominantly for weight loss, it seems that GLP-1s will have widespread benefits on comorbidities relating to obesity, including asthma,” Heatley said. “Quantifying these associations will be useful in considering the health economic choices around using these drugs.”
The researchers also noted that further work is needed to define successful outcomes among patients with different asthma phenotypes, such as low type 2 severe asthma.
Perspective
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Susan Cornell, PharmD, CDE, FAPhA, FAADE
I am not surprised by the results, and I do believe there is significance in these data. People with overweight or obesity often have numerous comorbidities including cardiovascular, renal, hepatic, cognitive and respiratory comorbidities, as well as sleep apnea, to list a few. By reducing the weight burden to the body, these related conditions can improve, including asthma.
Many of the people with diabetes that I work with have commented on improved sleep since starting a GLP-1 RA. The weight loss can improve sleep apnea and enhance better circulation, which may result in improved pulmonary outcomes.
GLP-1 RAs are cardio-renal metabolic medications that can also lower glucose. As with all drugs, there are side effects. It is critical for health care professionals to educate patients on the side effects and inform them about lifestyle tips to reduce them.
Healthy eating also is important in most health conditions, including weight management. Referrals to a registered dietician, certified diabetes care and education specialist and/or pharmacist can help people better manage their lifestyle and medications.
Keep in mind that GLP-1 RAs are medications for diabetes and weight loss, not for asthma. But improving asthma might be a side benefit of these drugs.
Lastly, beware of counterfeit GLP-1 RAs, as they may cause more harm than good.
GLP-1 RAs are currently being studied in numerous conditions other than diabetes and weight loss. To know if this is a direct or indirect effect, research needs to look at if GLP-1 RAs can improve asthma without weight loss.
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Kaplan A, et al. Poster 3920. Presented at: European Respiratory Society International Congress; Sept. 7-11, 2024; Vienna.
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