Complications? What Complications? (just another GLP-1 receptor agonist post)

SupremeCmdr

February 8

Adverse events are common in those using GLP-1 agonists, but the vast majority of these are minor. GI adverse effects are most common (20-70% of patients). Greater rate of GI effects with higher doses.

Most common problems: nausea (overall most common), vomiting, and diarrhea. Others included abdominal pain, dyspepsia, and constipation.

Symptoms are typically more severe within the first four weeks of therapy or with sudden escalation of therapy and tend to decrease over time.

Thought to be due to reduced gastric emptying and activation of centers involved in appetite regulation and nausea.

Severe diarrhea and vomiting may lead to volume loss, dehydration, and hypotension (not common).

There is an association with pancreatitis. GLP-1 agonists may stimulate pancreatic islet beta cells and exocrine duct cells leading to overgrowth and smaller duct size, which increase the pancreatic weight and risk of ductal occlusion.

Retrospective study published in 2022 of 81,752 adverse events associated with GLP-1 agonist therapy found an increased risk of pancreatitis, particularly with liraglutide (ROR 32.67; 95% CI 29.44-36.25). 2023 observational study found increased risk of pancreatitis (adjusted HR of 9.09, 95% CI 1.25-66).

Other GI issues include gallbladder and biliary tract disease (usually after 26 weeks of therapy and included cholelithiasis, cholecystitis, cholangitis), elevated LFTs, hepatitis, liver injury.

emDOCs Podcast – Episode 94: GLP-1 Agonist Complications -- https://www.emdocs.net/?s=glp-1