GLP-1 RAs Reduce Anemia Risk in Patients with Celiac Disease

New research is shedding light on the benefits of GLP-1 receptor agonist use in patients with celiac disease, including a significant survival benefit and reduced risk of iron deficiency anemia.1

The data were presented at the American College of Gastroenterology (ACG)’s 2025 Annual Scientific Meeting by Jonathan Ghobrial, MD, an internal medicine resident at Allegheny Health Network Medicine Institute, and pose important implications for reducing nutritional deficiency risk in a patient population prone to malabsorption.1

Widely used in the management of type 2 diabetes and obesity, GLP-1 receptor agonists have grown in popularity across multiple specialties as the class continues to earn more indications across a diverse set of disease states, including chronic kidney disease, metabolic dysfunction-associated steatohepatitis, obstructive sleep apnea, and more. With the widespread uptake of GLP-1s, emerging data highlights their influence on GI function and nutrient uptake.2,3

“Their impact on nutritional deficiencies and clinical outcomes in patients with celiac disease has not been well characterized,” Ghobrial and colleagues wrote.1 “This study is the first to evaluate the association between GLP-1 agonist use and key clinical outcomes, including anemia, transfusion, hospitalization, and mortality, in a large-scale analysis of patients with celiac disease.”

Investigators sourced data for the present study from TriNetX and identified patients with celiac disease using ICD-10 codes, stratifying them according to documented exposure to GLP-1 agonists, including semaglutide, dulaglutide, liraglutide, or exenatide. They then used 1:1 propensity score matching based on demographics, comorbidities, and relevant lab values.1

Clinical outcomes of interest included mortality, iron deficiency anemia, transfusion, B12/folate deficiency, GI bleeding, and hemoglobin trends.1

A total of 18,582 matched patients, 9291 in each group, were analyzed. Investigators noted GLP-1 users had significantly lower mortality (1.9% vs 3.3%; hazard ratio [HR], 1.82; 95% CI, 1.51–2.20; P <.001) and fewer transfusions (0.9% vs 1.3%; HR, 1.50; P = .004), while non-GLP1 users had a higher risk of iron deficiency anemia (5.4% vs 6.5%; HR, 1.26; P = .001).1

Further analysis revealed a reduced risk of B12 or folate deficiency in the GLP-1 group (0.8% vs 1.3%; HR, 1.62; P = .001). While GI bleeding rates were slightly greater in the GLP-1 group by time-to-event analysis (HR, 1.21; P = .044), investigators pointed out absolute risk was similar.1

“In a patient population that is prone to nutritional deficiencies due to malabsorption, particularly iron deficiency anemia, these results highlight a potential way to reduce these deficiencies,” investigators concluded.1 “Although by what means GLP-1 agonists confer a reduced risk of iron deficiency anemia in celiac patients is not understood from this study, further studies are warranted to further evaluate these findings.”

References

1. Ghobrial J, Youssef M, Abdelwahab A, et al. Reduced Risk of Iron Deficiency Anemia With GLP-1 Use in Celiac Disease Patients. Presented at the American College of Gastroenterology (ACG)’s 2025 Annual Scientific Meeting. Phoenix, Arizona. October 27-29, 2025.

2. Brooks A. FDA Approves Semaglutide (Ozempic) for Type 2 Diabetes, Chronic Kidney Disease. HCPLive. January 28, 2025. Accessed October 28, 2025. https://www.hcplive.com/view/fda-approves-semaglutide-ozempic-type-2-diabetes-chronic-kidney-disease

3. Brooks A. FDA Approves Semaglutide (Wegovy) Injection 2.4 mg for Noncirrhotic MASH. HCPLive. August 15, 2025. Accessed October 28, 2025. https://www.hcplive.com/view/fda-approves-semaglutide-wegovy-injection-2-4-mg-for-noncirrhotic-mash