Patients with type 2 diabetes who used glucagon-like peptide-1 receptor agonists had a 27% higher risk of developing gastroesophageal reflux disease compared with those using sodium–glucose cotransporter-2 inhibitors, according to a recent study.
Researchers conducted a population-based cohort study evaluating the association between glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and gastroesophageal reflux disease (GERD) in patients with type 2 diabetes (T2D).
Utilizing data from the U.K. Clinical Practice Research Datalink, the researchers, led by Yunha Noh, Pharm D, PhD of the College of Pharmacy, Chonnam National University, Gwangju, South Korea, and colleagues, employed an active-comparator new-user design to emulate a target trial. Adults aged 18 years or older who initiated GLP-1 RAs or sodium–glucose cotransporter-2 (SGLT-2) inhibitors between January 1, 2013, and December 31, 2021, were followed until March 31, 2022. Patients with prior GERD, related symptoms or treatment, or gastrointestinal disorders affecting motility were excluded. Propensity score fine stratification was applied to address confounding.
The study population included 24,708 new users of GLP-1 RAs and 89,096 new users of SGLT-2 inhibitors. Over a median follow-up of 3 years, the incidence of GERD was 3.1 per 100 patients in the GLP-1 RA group compared with 2.4 per 100 patients in the SGLT-2 inhibitor group. This corresponded to a risk difference (RD) of 0.7 per 100 patients and a risk ratio (RR) of 1.27. For GERD-related complications, which primarily included Barrett esophagus, the incidence was 2.1 per 1,000 patients in the GLP-1 RA group and 1.4 per 1,000 patients in the comparator group (RD, 0.8; RR, 1.55).
Subgroup analyses demonstrated higher risks among ever-smokers (RR, 1.83) and patients with obesity, particularly those with body mass index between 35 and 39.9 kg/m² (RR, 2.34). Sensitivity analyses using alternate definitions and comparator groups supported the primary findings. When compared with dipeptidyl peptidase-4 inhibitors, the RR for GERD was 1.09.
These findings suggest that GLP-1 RAs may increase the risk of GERD and its complications in patients withT2D. The researchers emphasized the need for clinicians to consider gastrointestinal risk factors when initiating GLP-1 RAs.
Full disclosures can be found in the published study.
Source: Annals of Internal Medicine