Tolerability and Effectiveness of Glucagon-Like Peptide-1 Receptor Agonists in Lung Transplant Recipients: A Single Center Report.

Claire E Fishman, Ciara Walshe, Tamara Claridge, Stephanie Witek, Krishna Pandya, Jason D Christie, Joshua M Diamond, Michaela R Anderson
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Abstract

Introduction: Diabetes and obesity increase risk of death after lung transplantation. Optimal treatment of diabetes and obesity may improve post-transplant outcomes. Glucagon-like peptide-1 receptor agonists (GLP-1RA) are FDA-approved to treat diabetes and obesity and demonstrate improvement in renal and cardiovascular outcomes in the general population. However, side effects may limit tolerability in lung transplant recipients. We hypothesized that GLP-1RA would be stopped due to side effects in a higher proportion of lung transplant recipients compared to the general population but result in weight loss for those who were able to tolerate them.

Methods: We performed a single-center case series of lung transplant recipients initiated on a GLP-1RA post-transplant between April 1, 2005 and December 31, 2023. We assessed side effects and complications during GLP-1RA use. Weight was assessed at time of GLP-1RA initiation and 3-, 6-, and 12-months postinitiation.

Results: Fifty-nine lung transplant recipients initiated a GLP-1RA during the study period with a median (IQR) total time of use of 590 (280-891) days. Thirty-seven percent (22/59) stopped the medication due to side effects, with nausea and vomiting being most common. The median (IQR) percent change in weight at 12-months post-GLP-1RA initiation was -2.5% (-8.7% to 1.5%).

Discussion: We report the largest study evaluating GLP-1RA use in lung transplant recipients. Discontinuation rates are higher and weight loss is lower than in the general population. However, most lung transplant recipients tolerated long-term use of GLP-1RA. Further work is required to identify which recipients are most likely to benefit and how to optimize tolerability.

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简介:糖尿病和肥胖会增加肺移植后的死亡风险:糖尿病和肥胖会增加肺移植后的死亡风险。对糖尿病和肥胖症进行最佳治疗可改善移植后的预后。胰高血糖素样肽-1受体激动剂(GLP-1RA)已获美国食品及药物管理局批准用于治疗糖尿病和肥胖症,并证明可改善普通人群的肾脏和心血管预后。然而,副作用可能会限制肺移植受者的耐受性。我们假设,与普通人群相比,较高比例的肺移植受者会因副作用而停用 GLP-1RA,但能够耐受的受者体重会减轻:我们对 2005 年 4 月 1 日至 2023 年 12 月 31 日期间开始使用 GLP-1RA 的肺移植受者进行了单中心病例系列研究。我们评估了使用 GLP-1RA 期间的副作用和并发症。在开始使用 GLP-1RA 时以及开始使用后的 3 个月、6 个月和 12 个月对体重进行了评估:59例肺部移植受者在研究期间开始使用GLP-1RA,总使用时间的中位数(IQR)为590(280-891)天。37%(22/59)的受者因副作用而停药,其中恶心和呕吐最为常见。开始服用GLP-1RA后12个月的体重变化百分比中位数(IQR)为-2.5%(-8.7%至1.5%):讨论:我们报告了评估肺移植受者使用 GLP-1RA 的最大规模研究。与普通人群相比,GLP-1RA 的停药率较高,体重减轻率较低。不过,大多数肺移植受者都能耐受长期服用 GLP-1RA。还需要进一步研究确定哪些受者最有可能受益,以及如何优化耐受性。
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