GLP-1 agonists may improve respiratory outcomes among patients with COPD, type 2 diabetes
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Key takeaways:
- GLP-1 agonists and co-agonists conferred better respiratory and mortality outcomes among patients with COPD and type 2 diabetes.
- They also lowered recurrent risk for pneumonia, pulmonary edema and intubation.
BOSTON — Patients with both COPD and type 2 diabetes who used GLP-1 agonists or co-agonists had improved respiratory outcomes vs. those who used other type 2 diabetes medications, according to data presented at the CHEST Annual Meeting.
“GLP-1 agonists may potentially be used to reduce the risk of COPD exacerbation and other complications,” Nutchapon Xanthavanij, MD, of Mount Auburn Hospital in Cambridge, Massachusetts, told Healio.
To assess the impact of GLP-1 agonists and co-agonists on other respiratory outcomes, Xanthavanij, Xin Ya See, MD, Cho Han Chiang, MD, and colleagues conducted a retrospective cohort study of 393,106 patients aged 18 years and older in the TriNetX Analytics Network database who were diagnosed with both COPD and type 2 diabetes between April 2005 and March 2023.
The researchers divided the total cohort into two groups: patients who received GLP-1 agonists or co-agonists and those who received other type 2 diabetes medications.
The primary outcomes of the study included all-cause mortality, incident COPD exacerbation, oxygen dependence and pulmonary hypertension; secondary outcomes included recurrent bronchitis, pneumonia, intubation and pulmonary edema.
After 1:1 propensity score matching, the final study population included 28,447 patients in both the GLP-1 group and the control group.
Results of Cox proportional hazard analyses showed that the use of GLP-1 agonists or co-agonists was associated with lower all-cause mortality (HR = 0.54; 95% CI, 0.5-0.58) and risk for incident COPD exacerbation (HR = 0.88; 95% CI, 0.81-0.96), oxygen dependence (HR = 0.77; 95% CI, 0.7-0.84) and pulmonary hypertension (HR = 0.78; 95% CI, 0.7-0.87).
“It was particularly striking to observe that GLP-1 agonists were associated with a 48% reduction in all-cause mortality in COPD patients,” Xanthavanij said. “Previous meta-analyses have shown a 12% reduction in all-cause mortality in the general population with type 2 diabetes mellitus using GLP-1 agonists, but our findings indicate a greater degree of mortality reduction in COPD patients. This effect cannot be fully explained by GLP-1 agonists’ cardiovascular and renal benefits alone. It may be related to the reduction in pulmonary complications, the weight loss effect or other unknown mechanisms in COPD patients.”
They also found an association between the use of GLP-1 agonists or co-agonists and lower recurrent risk for pneumonia (HR = 0.8; 95% CI, 0.75-0.84), pulmonary edema (HR = 0.77; 95% CI, 0.7-0.85) and intubation (HR = 0.64; 95% CI, 0.55-0.75).
The researchers were surprised to find that GLP-1 agonists showed this significant reduction in pulmonary complications, Xanthavanij said.
“While the exact mechanisms remain unclear, preclinical studies suggest GLP-1 agonists may reduce oxidative stress and inhibit inflammatory factors, potentially improving airway inflammation and airflow limitation in COPD,” he said.
Additionally, researchers observed a higher risk for gastroparesis among patients who received GLP-1 agonists or co-agonists (HR = 1.22; 95% CI, 1-1.48).
However, the researchers noted that there were no differences in the risk for bowel obstruction, biliary disease and pancreatitis between both groups.
“Our findings would support future clinical trials investigating the use of GLP-1 agonists in patients with COPD,” Xanthavanij said. “The effect of weight loss should also be taken into account.”
The researchers acknowledged several study limitations, including that despite using a large database, they did not have access to patients’ primary records.
“Also, diagnoses used in the analyses are classified by ICD-10, which could be subject to bias due to undercoding or miscoding,” Xanthavanij said. “The findings are promising, but prospective studies — particularly randomized controlled trials — are warranted to confirm these results.”
For more information:
Nutchapon Xanthavanij, MD, can be reached at nutchapon1995@hotmail.com.
Xin Ya See, MD, can be reached at xyxinyasee@gmail.com.
Cho Han Chiang, MD, can be reached at chiangchohan1129@gmail.com.