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IMPACT OF GLP1 AGONIST THERAPY ON ILEAL POUCH ANAL ANASTOMOSIS PATIENT FUNCTIONAL OUTCOMES AND QUALITY OF LIFE
Ece Unal
*, Olga Lavryk, Arielle E. Kanters, Anna R. Spivak, Jeremy M. Lipman, Katherine Falloon, Taha Qazi, Benjamin L. Cohen, Stefan D. Holubar
Colorectal Surgery, Cleveland Clinic, Cleveland, OH
Background: Total proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the standard operative treatment for patients with medically refractory inflammatory bowel disease or familial adenomatous polyposis requiring colectomy. Frequency and consistency of bowel function can be a challenge for post-IPAA patients and significantly impact their wellbeing and quality of life. We hypothesized that GLP1 agonist therapy (GLP1) will lead to improved functional outcomes (eg. frequency of bowel function, quality of life) and weight loss in colorectal patients post-IPAA reconstruction.
Methods: We retrospectively reviewed for adults who underwent IPAA and placed on postoperative GLP1 from 2008 to 2022. Demographics, operative data, complications, functional outcomes and quality of life results were collected before and after initiation of GLP1. Patients who were prescribed GLP1 but were not able to use it due to side effects or insurance coverage were excluded.
Results: A total of 14 patients were identified to have undergone IPAA and subsequently had continued GLP1 agonist therapy.
Ten patients were excluded, of which two patients (2/16, 12.5%) discontinued GLP1 due to side effects profile (nausea and loss of appetite). Median age was 53 years old (44-59 years old); 64.3% (n=9) were female). The majority of patients initially underwent IPAA for medically refractory ulcerative colitis (12, 85.7%); other diagnoses included Crohn’s disease (1, 7.1%) and familial adenomatous polyposis (1, 7.1%). Most patients were prescribed a formulation of semaglutide (6, 42.9%) or tirzepatide (5, 35.7%). Almost patients underwent either 3-stage (7, 50%) or 2-stage (6, 42.9%) proctocolectomy with IPAA; all were J pouch with stapled anastomosis. Time from operative intervention to GLP1 initiation was 7.48 years (4.7-9.9 years).
Median duration of GLP1 therapy was 24.3 months (8-37 months). Overall a statistically significant difference in functional outcomes and quality of life was not found before or after IPAA. A clinically significant decrease in use of bowel stoppers (47% decrease) and other agents, such as antibiotics, laxatives or advanced therapies, (33.3% decrease) was seen. Overall functional outcomes and change in BMI before and after GLP1 is shown in
Table 1.
Conclusions: In this case series, which is the second of its kind in the literature to the authors’ knowledge, GLP1 agonist therapy was well tolerated in patients with IPAA. Although not statistically significant, a clinical reduction in use of bowel stoppers and use of other IBD agents was noticed before and after GLP1 therapy. A matched study to control patients is underway to see the impact of GLP1 compared to control patients, which will help shed light on the impact of GLP1 agonist therapy on IPAA functional outcome.
Table 1. Comparison of Weight & Functional Outcomes Before and After GLP1 Therapy
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