Systematic review and meta-analysis of glucagon-like peptide 1 receptor agonists (GLP1-RAs) safety and efficacy in patients with inflammatory bowel disease

Objective Obesity and type 2 diabetes mellitus are increasingly common in patients with inflammatory bowel disease (IBD) and are associated with adverse clinical outcomes. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are effective metabolic therapies with potential anti-inflammatory effects but their safety and effectiveness in IBD remain unclear. We conducted a systematic review and meta-analysis to evaluate metabolic, clinical and safety outcomes associated with GLP-1 RA use in IBD. Methods MEDLINE, EMBASE, Web of Science and major international conference proceedings were searched from inception to 1 October 2025. Randomised controlled trials and observational studies evaluating GLP-1 RAs in adults with Crohn’s disease or ulcerative colitis were included. Pre-post and comparative studies were analysed separately, with random-effects meta-analyses performed when at least three studies reported an outcome. Results 23 studies including 150 254 patients were analysed. In pre-post studies, GLP-1 RA therapy significantly reduced body mass index (mean difference −3.34 kg/m²; 95% CI −4.05 to −2.20) and modestly lowered HbA1c (−0.17%; 95% CI −0.33 to −0.01). In comparative analyses, GLP-1 RA use was associated with lower risks of IBD-related hospitalisation (RR 0.76; 95% CI 0.58 to 1.00), IBD-related surgery (RR 0.68; 95% CI 0.54 to 0.85) and ileus or intestinal obstruction (RR 0.53; 95% CI 0.35 to 0.79). Gastrointestinal adverse events were common leading to treatment discontinuation in 11–24% of patients. Conclusion GLP-1 RAs appear safe in patients with IBD and are associated with clinically meaningful weight loss and favourable IBD-related outcomes. Although causality cannot be inferred, these findings support the need for randomised controlled trials. PROSPERO registration number CRD420261350546.