New Research Supports GLP-1 RA Use in IBD for Weight Loss, Disease Control

Obesity rates are rising across the US, with an estimated 1 in 5 adults in each state living with obesity. According to the US Centers for Disease Control and Prevention, the prevalence of obesity in US adults was 40.3% from 2021–2023.1,2

Despite historical perceptions of inflammatory bowel disease (IBD) as a disease of malabsorption and underweight, patients with IBD are no exception to the obesity epidemic.

“In patients with IBD, [obesity] is not just associated with cardiometabolic disease, but also worsened IBD outcomes, increased disease flares, needs for surgery, and surgical complications, so it's incredibly important that we find a safe and effective treatment strategy,” Stephanie Gold, MD, an instructor of medicine at the Icahn School of Medicine at Mount Sinai and a gastroenterologist at the Mount Sinai Hospital, explained to HCPLive.

While GLP-1 receptor agonists (GLP-1 RAs) have become an increasingly popular weight loss tool and may offer a potential solution to the rising rates of obesity, research on their use in IBD is limited.

Seeking to address this gap in research, Gold and Elizabeth Spencer, MD, MS, an assistant professor of pediatrics in the division of pediatric Gastroenterology at the Icahn School of Medicine at Mount Sinai and at the Mount Sinai Kravis Children’s Hospital, presented 4 abstracts on the use of GLP-1 RAs in patients with IBD at Digestive Disease Week (DDW) 2025, exploring recent prescribing trends, differences in patient demographics, as well as the safety and efficacy of this class of medications in this patient population.

Looking at GLP-1 RA prescription trends from 2020-2024 among patients with IBD at Mount Sinai, they found 6% of patients in the cohort were prescribed GLP-1 RAs—primarily for obesity—with semaglutide as the most common agent. Endocrinologists and primary care providers initiated most prescriptions, while GI specialists accounted for only a small fraction.3

Importantly, Gold and Spencer’s research also demonstrated that GLP-1 RAs are safe in IBD populations, with minimal side effects and no evidence of worsening disease activity. They were also effective, with patients achieving average weight loss of 5%, 8%, and 10% at 3, 6, and 12 months, respectively, and rates of clinical remission in IBD improving over time.4

“We have a medication that we know is effective and safe and may impact IBD outcomes,” Gold said. “For us, it was a win-win.”

“Most of the data so far on GLP-1s in IBD have come from big registry data where they don't have this kind of granularity on the clinical outcomes,” Spencer added. “They've talked about hospitalizations and surgeries, but they don't actually have the disease activity from the office visits, so this is something novel that we're able to present.”

Their research also confirmed the safety and efficacy of GLP-1 RAs in patients with perianal fistulizing Crohn’s disease, yielding “excellent” weight loss and a reduced need for surgical intervention relative to the year prior.5

Phenotypically, Gold and Spencer found GLP-1 RA recipients were more likely to have less severe disease, colonic involvement, and later-onset Crohn’s, potentially reflecting physician hesitancy to use GLP-1 RAs in patients with more severe disease, though Spencer noted further research is needed.6

Looking ahead, both experts emphasize the need for prospective studies to explore GLP-1 RA use beyond weight loss, including as adjunct therapy, in maintenance, and potentially for IBD prevention in high-risk populations. They also highlight interest in studying GLP-1 RAs in special IBD groups, such as patients with ileostomies or J-pouches, where slowed GI transit may offer added symptom relief.

Editors’ note: Gold and Spencer have not indicated any relevant disclosures.

References

1. US Centers for Disease Control and Prevention. New CDC Data Show Adult Obesity Prevalence Remains High. September 12, 2024. Accessed May 9, 2025. https://www.cdc.gov/media/releases/2024/p0912-adult-obesity.html

2. US Centers for Disease Control and Prevention. Obesity and Severe Obesity Prevalence in Adults: United States, August 2021–August 2023. September 2024. Accessed May 9, 2025. https://www.cdc.gov/nchs/products/databriefs/db508.htm

3. Gold SL, Freid H, Shalom ES, et al. TRENDS IN GLUCAGON-LIKE PEPTIDE-1 AGONIST (GLP-1A) PRESCRIBING FOR PATIENTS WITH INFLAMMATORY BOWEL DISEASE. Abstract presented at Digestive Disease Week 2025 in San Diego, CA, from May 3 - May 6, 2025.

4. Gold SL, Freid H, Shalom ES, et al. GLUCAGON-LIKE PEPTIDE-1 AGONISTS IN INFLAMMATORY BOWEL DISEASE LEAD TO SIGNIFICANT WEIGHT LOSS AND IMPROVED CLINICAL REMISSION WITH MINIMAL SIDE EFFECTS. Abstract presented at Digestive Disease Week 2025 in San Diego, CA, from May 3 - May 6, 2025.

5. Bergenholtz S, Gold SL, Spencer EA, et al. GLUCAGON-LIKE PEPTIDE-1 RECEPTOR AGONIST USE IN PATIENTS WITH PERIANAL FISTULIZING CROHN’S DISEASE IS WELL TOLERATED AND LEADS TO WEIGHT LOSS AND CLINICAL IMPROVEMENT IN FISTULA ACTIVITY. Abstract presented at Digestive Disease Week 2025 in San Diego, CA, from May 3 - May 6, 2025.

6. Spencer EA, Shalom ES, Freid H, et al. PATIENTS WITH INFLAMMATORY BOWEL DISEASE (IBD) PRESCRIBED GLUCAGON-LIKE PEPTIDE-1 AGONISTS HAVE LESS SEVERE DISEASE AND REDUCED ADVANCED THERAPY UTILIZATION COMPARED TO THE GENERAL IBD POPULATION. Abstract presented at Digestive Disease Week 2025 in San Diego, CA, from May 3 - May 6, 2025.