Can GLP-1 agonists be used safely in inflammatory bowel disease? A meta-analysis

Abstract Background Obesity is increasingly recognized as a common comorbidity in patients with inflammatory bowel disease (IBD). Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are widely used for weight reduction and cardiometabolic risk management. However, their safety and effectiveness in individuals with IBD remain uncertain. Methods We conducted a systematic review through June 2025 to identify studies involving adult patients with IBD treated with GLP-1RAs. Primary outcomes included hospitalization, corticosteroid use, treatment escalation, risk of flare, and IBD-related surgery. Secondary outcomes were changes in weight and body mass index (BMI). Results Ten observational studies, comprising 10 362 patients with IBD (3479 receiving GLP-1RAs and 6883 receiving placebo or other anti-obesity medications) were included. The pooled incidences of hospitalization, corticosteroid use, treatment escalation, flare, and surgery among patients receiving GLP-1RAs were 11%, 11%, 8%, 14%, and 3%, respectively. Use of GLP-1RAs in IBD patients was not associated with an increased risk of corticosteroid use (OR: 0.93; 95% CI: 0.17-5.16; I2 = 11.4%), treatment escalation (OR: 0.70; 95% CI: 0.06-7.62; I2 = 0%), or IBD-related surgery (OR: 0.32; 95% CI: 0.00-313.88; I2 = 92.5%) compared to non-GLP-1 users. Patients treated with GLP-1RAs achieved a percentage total body weight loss of 6.67% (95% CI: 2.93%-10.40%; I2 = 0%), a mean absolute weight loss of 7.33 kg (95% CI: 6.03-8.63; I2 = 0%) and a BMI reduction of 2.48 kg/m2 (95% CI: 0.79-4.17; I2 = 0%) compared to baseline. Conclusion GLP-1RAs appear to be safe and effective in patients with IBD.