Glucagon-like peptide-1 (GLP-1) receptor agonists in inflammatory bowel disease: mechanisms, clinical implications, and therapeutic potential
Michael Colwill, Sebastian Povlsen, Richard Pollok, Kamal Patel, James Goodhand, Tariq Ahmad, Sailish Honap
Abstract
Glucagon-like peptide-1 receptor agonists are increasingly recognized for their potential dual benefit in inflammatory bowel disease (IBD), offering metabolic advantages alongside emerging anti-inflammatory, immunomodulatory, and gut barrier-enhancing effects. Pre-clinical data demonstrate attenuation of inflammation, preservation of epithelial integrity, and modulation of the microbiome in colitis models. Early retrospective studies in patients with IBD suggest improved clinical outcomes, such as reduced hospitalization and surgery rates, particularly in those with obesity. Glucagon-like peptide-1 receptor agonists are already widely used for obesity and diabetes, including increasing self-administration by patients outside medical supervision. Their impact on drug absorption, safety in gastrointestinal disease, and interactions with existing IBD therapies require further exploration. This review synthesizes the mechanistic rationale, pre-clinical evidence, and clinical data to date, highlighting the potential utility and safety considerations of glucagon-like peptide-1 receptor agonists in IBD and emphasizes the need for robust prospective trials to ascertain their safety and efficacy in this patient population.