A new study presented at this year’s European Congress on Obesity (12-15 May) in Istanbul, Turkey, showed that the use of a new GLP-1 class of obesity drugs in asthma patients was associated with a 26% reduction in the number of asthma exacerbations and a 14% reduction in the use of asthma inhaled painkillers. This study was conducted by Simon Høj and Dr. Kjell Erik Julius Håkansson from Copenhagen University Hospital in Copenhagen, Denmark.
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are currently widely used in the treatment of overweight, obesity, and type 2 diabetes mellitus (T2DM), with increasing evidence demonstrating benefits beyond glycemic control.
In asthma, where overweight, obesity, and metabolic dysfunction can lead to adverse events such as increased symptom severity and acute exacerbations, the authors suggest that GLP-1 RAs may improve asthma outcomes through weight loss, modulating airway inflammation, and improving metabolic function.
Reducing the incidence of asthma exacerbations may reduce systemic corticosteroid exposure (a common treatment for acute asthma exacerbations, either orally or intravenously) and thus reduce the risk of adverse events associated with corticosteroid exposure, such as osteoporosis and new-onset T2DM. Therefore, as the clinical use of GLP-1 RAs expands, reliable estimates of the impact of GLP-1 RAs on asthma control are needed for individuals living with both asthma and overweight, obesity, or T2DM.
Researchers conducted a national self-controlled cohort study using linked Danish health registries. Adults who had previously been diagnosed with asthma or who had received 2 or more prescriptions for an asthma inhaler within 12 months were included on the first GLP-1 RA dispensing date (index date). Eligible individuals had continuous enrollment data for at least 12 months before and after the index date.
Patients with COPD or severe asthma who were treated with new, relatively expensive biologics within 12 months before or after the index date were excluded. Overweight or obesity was defined using ICD-10 codes for these conditions. People with no evidence of T2DM, no recorded diagnosis, or no other first-line diabetes medication prescribed were also classified into the obese/overweight group. Those with a diagnosis of T2DM or a recorded prescription for a first-line diabetes drug such as metformin were classified into the T2DM group.
The primary outcome was exacerbation, defined as hospital contact and/or administration of systemic oral or intravenous corticosteroids in hospitalized asthma patients. Secondary outcomes were chest infection events, defined as use of rescue medications (inhaled short-acting β2-agonists), exposure to inhaled corticosteroids, and reimbursement for antibiotics commonly used for lower respiratory tract infections.
The cohort consisted of 27,523 people (mean age 54 years, 66% female) with asthma and overweight or obesity (49%) or T2DM (61%), with 26% recorded as having both conditions. Approximately 50% of GLP-1 prescriptions were liraglutide, 48% semaglutide, and 2% other (exenatide, dulaglutide, lixisenatide).
Compared to 1 year before GLP-1 RA treatment, GLP-1 RA treatment was associated with a 26% reduction in overall exacerbation rate, with a 28% reduction in men and a 23% reduction in women. When stratified according to GLP1 RA treatment indication, the analysis showed that individuals with co-occurring asthma and overweight or obesity and individuals with co-occurring asthma and T2DM had similar effect estimates. It was reduced by 22% in patients with overweight or obesity and by 26% in patients with T2D.
The use of palliatives decreased by 14% overall, suggesting a reduction in symptoms even though daily inhaled corticosteroid exposure also decreased by 23% (inhaled corticosteroids are used to prevent asthma exacerbations and treat symptoms). Additionally, the incidence of pneumonia was reduced by 10%. People with allergic rhinitis also showed a similar reduction in exacerbations (23%) as people without allergic rhinitis (28%). The authors also work on updated analyzes showing differences between men and women on these specific outcomes.
The authors concluded, “In a national cohort of more than 27,000 people with asthma and overweight, obesity, or type 2 diabetes, the use of GLP-1 drugs was associated with significant reductions in exacerbation burden, palliative medication use, exposure to inhaled corticosteroids, and pneumonitis events, regardless of whether the drug was used to treat obesity or type 2 diabetes.”
The authors explain that their study did not have access to clinical records (only in cases of GLP-1 use or hospitalization), so data on participants’ BMI and weight loss were not available.
It is likely that weight loss contributes significantly to these results. A common symptom of both asthma and obesity is shortness of breath, and the presence of excess adipose tissue generally creates a pro-inflammatory state in the body. There is also evidence from other studies to suggest that the inflammation caused by excess fatty tissue is different from “classic” asthma inflammation, which is often caused by allergies and cells called eosinophils. ”
Kjell Erik Julius Håkansson, Ph.D., Postdoctoral Researcher, Copenhagen University Hospital
He added, “As the use of GLP-1 therapy increases, researchers are finding that effects beyond weight loss are also increasing.”
sauce:
European Obesity Research Association
