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GLP-1 receptor agonist, DPP-IV inhibitor alter bile acids
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Liraglutide may alter the intestinal microbiome, whereas sitagliptin may increase hepatic bile acid production in adults with type 2 diabetes, study data show.
Mark M. Smits, MD, of the Diabetes Center, department of internal medicine, VU University Medical Center in Amsterdam, and colleagues evaluated 56 adults (mean age, 62.8 years) with type 2 diabetes (mean HbA1c, 7.3%) treated with metformin and/or sulfonylureas randomly assigned to the glucagon-like peptide-1 receptor agonist liraglutide (Victoza, Novo Nordisk; n = 19) 1.8 mg, the DPP-IV inhibitor sitagliptin (Januvia, Merck; n = 20) 100 mg or placebo (n = 17) for 12 weeks to determine the effects of the therapies on gallbladder volume and bile acid profile.
Gallbladder fasting volume, residual volume, maximal ejection fraction and the area under the curve (AUC) of gallbladder were not affected by either treatment compared with placebo.
Fasting serum levels of deoxycholic acid were more increased with liraglutide compared with placebo (P = .024), and liraglutide also increased the postprandial AUC of deoxycholic acid (P = .005). No differences were observed in other serum individual bile acids, total bile acids, total conjugated and unconjugated bile acids, or total tauro- and glycine-conjugated bile acids between the treatment groups.
Total fecal bile acids were more increased with liraglutide (RR = 1.36; 95% CI, 0.97-1.91) and sitagliptin (RR = 1.36; 95% CI, 0.97-1.91) compared with placebo. Deoxycholic acid was increased with liraglutide without effects on other bile acids (RR = 1.5; 95% CI, 1.03-2.19). Chenodeoxycholic acid (RR = 3.42; 95% CI, 1.33-8.79), cholic acid (RR = 3.32; 95% CI, 1.26-8.87) and ursodeoxycholic acid (RR = 3.81; 95% CI, 1.44-10.14) were increased with sitagliptin.
“While liraglutide and sitagliptin have no effect on gallbladder emptying, both agents increase levels of bile acids, although differentially,” the researchers wrote. “The increase in fecal and serum bile acids during liraglutide treatment suggests alteration of intestinal microbiome, while sitagliptin appears to increase hepatic bile acid production.” – by Amber Cox
Disclosure: Smits reports no relevant financial disclosures.
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