GLP-1 receptor agonist therapy is associated with increased symptomatic remission in ulcerative colitis: a matched cohort study.

BACKGROUND

Ulcerative colitis (UC) remains associated with significant morbidity despite therapeutic advances. The impact of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) on UC disease activity is not well defined.

METHODS

We performed a retrospective cohort study using electronic health records from a single tertiary academic health system (2022-2024). Adults with UC initiating liraglutide or semaglutide for metabolic indications and maintained on therapy ≥ 12 weeks were included. A 1:1 matched cohort of UC patients not receiving GLP-1 RAs served as controls. The primary outcome was symptomatic remission at 12 weeks (partial Mayo ≤ 2 with rectal bleeding subscore 0). Multivariable logistic regression assessed adjusted odds of remission.

RESULTS

A total of 150 GLP-1 RA patients were matched to 150 controls with comparable baseline characteristics. GLP-1 RA use was associated with higher remission rates at 4 weeks (34.7% vs 15.3%, P = .001), 8 weeks (54.7% vs 18.0%, P < .001), and 12 weeks (66.7% vs 25.3%, P < .001). Mean partial Mayo scores improved from 5.8 at baseline to 2.1 at 12 weeks in the GLP-1 RA group vs 4.6 in controls (P < .01). GLP-1 RA use remained independently associated with remission (adjusted OR 5.90, 95% CI 3.52-9.86; P < .001). Weight loss was not associated with remission. Semaglutide demonstrated higher remission rates than liraglutide (72.5% vs 60%; OR 1.77, P = .04). Endoscopic outcomes in a subset showed higher remission (58% vs 38%) and improvement (69% vs 47%).

CONCLUSION

GLP-1 RA therapy was associated with significantly improved UC disease activity and higher remission rates compared to matched controls, with a modest advantage observed for semaglutide. These findings support a potential adjunctive role for GLP-1 RAs in UC, particularly in patients with metabolic comorbidities.