Ali Rezaie, MD: GLP-1 RAs and Pneumonia Aspiration Risk After GI Endoscopy

Findings from a recent study suggest the need to observe caution in glucagon-like peptide-1 receptor agonist (GLP-1RA) users who present for an upper endoscopy under deep sedation, calling attention to an increased risk of aspiration pneumonia in this patient population.

The research was presented at Digestive Disease Week (DDW) 2024 in Washington, DC, this weekend and provides novel insight into the inhibitory effect of GLP-1RAs on gastrointestinal tract motility in the context of endoscopic procedures.

In an interview with HCPLive, Ali Rezaie, MD, medical director of gastroenterology motility medicine and director of the bioinformatics and biotechnology medically associated science and technology (MAST) program at Cedars-Sinai, explained how GLP-1s slow down the gut, including the stomach, the small bowel, and the colon. The issue, he describes, is the growing half-life of these medications and the potential implications for the risk of aspiration following endoscopy.

To explore the risk of aspiration following GLP-1RA use, he and a team of investigators conducted a population-based, retrospective cohort study using the TriNetX dataset and included adult patients who underwent gastrointestinal endoscopies from 2018 to 2020. In total, 963,184 individuals who underwent gastrointestinal endoscopy were identified, including 916,249 GLP-1RA non-users and 46,935 users, 778,253 and 20,099 of whom were eligible for inclusion, respectively.

Upon analysis, GLP-1RA use was associated with a significantly increased risk of aspiration pneumonia (Hazard ratio [HR], 1.33; 95% CI, 1.02-1.74), with an incidence rate of 0.83% compared to 0.63% in non-users). Investigators observed an elevated risk of aspiration pneumonia among patients who had propofol during their procedure (HR, 1.49; 95% CI, 1.08-2.06), but the association was not significant among those who did not have propofol during the procedure (HR, 1.31; 95% CI, 0.78-2.20).

Of note, the increased risk of aspiration pneumonia in GLP-1RA users was only observed among patients who underwent upper endoscopy (HR, 1.82; 95% CI, 1.27-2.60) and combined upper and lower endoscopy (HR, 2.26; 95% CI, 1.23-4.16), but not lower endoscopy (HR, 0.56; 95% CI, 0.25-1.27).

Rezaie noted that although GLP-1RAs only increased the risk of aspiration pneumonia by about 0.2%, this equates to a 33% increment in baseline risk. “Yes, it is a small increase, but it is significant in the sense that we are doing 20 million endoscopies per year,” he explained, describing stopping GLP-1RA use as a “very easy intervention that can save a lot of lives.”

Reference:

^{Yeo YH, Gaddam S, Ng WH, et al. ASSOCIATION OF GLP-1RA USE AND ASPIRATION PNEUMONIA AFTER THE ENDOSCOPIC PROCEDURE: REAL-WORLD DATA FROM A LARGE NATIONAL DATABASE. Abstract presented at Digestive Disease Week (DDW) 2024 Annual Meeting. Washington, DC. May 17-21, 2024.}