Use of GLP-1 receptor agonists and dual agonists in patients with inflammatory bowel disease

Abstract

Background: Obesity represents a growing epidemiological problem in patients with inflammatory bowel disease (IBD), affecting up to 40% of patients. Excess adipose tissue worsens clinical prognosis, sustains systemic inflammation, and accelerates the loss of response to biological therapy. Aim: The aim of this study was to summarize current knowledge regarding the use of glucagon-like peptide-1 receptor agonists (GLP-1RAs) and dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonists (tirzepatide) in this patient group. Materials and methods: PubMed Scopus, Web of Science, and Cochrane Library databases were searched from their inception through September 2026 using a combination of relevant keywords. A total of 20 studies were included in the review. Results: Incretin-based therapies demonstrate immunomodulatory and intestinal barrier–protective effects. Real-world studies and meta-analyses show that semaglutide, liraglutide, and tirzepatide induce significant weight loss (6–12%+), reduce C-reactive protein levels, hospitalization rates, corticosteroid use, and the risk of IBD-related surgery by up to 55%. These agents are generally well tolerated and are not associated with an increased risk of IBD exacerbations. Delayed gastric emptying remains an important consideration, particularly in patients receiving oral thiopurines due to the potential for altered drug pharmacokinetics and hepatotoxicity. Conclusions: GLP-1 and GIP/GLP-1 agonists represent a highly promising, safe adjunctive therapy for patients with IBD and metabolic disorders. Results from ongoing randomized controlled trials will allow for the definitive establishment of their position in gastroenterological guidelines.