New data links GLP-1 agonists for weight loss with higher risk for pancreatitis, GI events
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Key takeaways:
- GLP-1 agonists were associated with a 9.09 times increased risk for pancreatitis.
- Use of these drugs also was linked with a 4.22- and 3.67-times higher risk for bowel obstruction and gastroparesis, respectively.
Use of glucagon-like peptide 1 agonists for weight loss compared with bupropion-naltrexone was associated with an increased risk for pancreatitis, gastroparesis and bowel obstruction but not biliary disease, researchers reported in JAMA.
“Given the wide use of these drugs, these adverse events, although rare, must be considered by patients thinking about using them for weight loss,” Mohit Sodhi, MSc, a fourth-year medical student at the University of British Columbia, said in a related press release. “The risk calculus will differ depending on whether a patient is using these drugs for diabetes, obesity or just general weight loss. People who are otherwise healthy may be less willing to accept these potentially serious adverse events.”
Using a random sample of 16 million patients from the PharMetrics Plus database, Sodhi and colleagues evaluated gastrointestinal adverse events among new users of GLP-1 agonists liraglutide (n = 4,144) or semaglutide (n = 613) between 2006 and 2020. Researchers compared outcomes with users of another weight loss drug, bupropion-naltrexone (n = 654), and monitored all patients for development of biliary disease, pancreatitis, bowel obstruction or gastroparesis.
“There have been anecdotal reports of some patients using these drugs for weight loss and then presenting with repeated episodes of nausea and vomiting secondary to a condition referred to as gastroparesis,” senior author Mahyar Etminan, MSc, PharmD, an epidemiologist and associate professor in the university’s department of ophthalmology and visual sciences, said in the release. “But until now, there hasn’t been any data from large epidemiologic studies.”
Results showed use of GLP-1 agonists compared with bupropion-naltrexone correlated with a 9.09 (95% CI, 1.25-66), 4.22 (95% CI, 1.02-17.4) and 3.67 (95% CI, 1.15-11.9) times higher risk for pancreatitis, bowel obstruction and gastroparesis, respectively. However, GLP-1 agonists were not associated with an increased risk for biliary disease (HR = 1.5; 95% CI, 0.89-2.53).
“These drugs are becoming increasingly accessible, and it is concerning that, in some cases, people can simply go online and order these kinds of medications when they may not have a full understanding of what could potentially happen,” Sodhi said. “This goes directly against the mantra of informed consent.”
Sodhi continued: “This is critical information for patients to know so they can seek timely medical attention and avoid serious consequences.”
Reference:
- The University of British Columbia. First epidemiological study links popular weight-loss drugs to stomach paralysis, other serious gastrointestinal conditions. Available at: https://news.ubc.ca/2023/10/05/diabetes-weight-loss-drug-leads-to-gastrointestinal-issues/#:~:text=That's%20according%20to%20new%20research,paralysis%2C%20pancreatitis%20and%20bowel%20obstruction. Accessed: Oct. 05, 2023.
Perspective
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Roberto Simons-Linares, MD
Medications like GLP-1 agonists are becoming increasingly common to treat not only diabetes but also obesity. This study may have found an increase in risk for adverse events like bowel obstruction and gastroparesis, but there are a few points that we should keep in mind. The risk of adverse events is real, but it is very small compared with the benefits of these medications.
The study lacks granular data that really investigates how these complications arose in patients. Study participants may have had preexisting biliary or pancreatic biliary problems or other gut problems before taking the medications. The data is valuable and highlights the importance of knowing and understanding a patient’s past medical history.
We should be very transparent and discuss side effects with our patients. All medications have side effects; therefore, it is important to look at the best treatment options with the lowest risks for a given patient.
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