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GLP-1 therapy in Crohn's disease: Fewer steroids, hospitalizations

“What stood out most was the consistent association between GLP-1 receptor agonist use and lower steroid dependence."

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Glucagon-like peptide-1 receptor (GLP-1) agonists, widely used to treat obesity and diabetes, may also improve key outcomes for patients with Crohn’s disease, according to a large real-world study presented during the 2026 Crohn’s & Colitis Congress®, a partnership of AGA and the Crohn's & Colitis Foundation, taking place in Las Vegas. 
 
“Obesity is now very common among patients with Crohn’s disease, yet there is limited guidance on how newer metabolic medications, particularly GLP-1 receptor agonists affect Crohn’s-related outcomes,” presenting author Nakul Ganju, MD, an internal medicine resident at Howard University Hospital in Washington, DC, told GI & Hepatology News. “These medications are being prescribed more frequently for obesity and diabetes, so gastroenterologists are increasingly encountering patients with Crohn’s disease who are already taking them. Our study addresses an important and practical question: whether GLP-1 receptor agonists appear safe in this population and whether their use is associated with meaningful clinical outcomes such as steroid dependence and hospitalization.”
 
The researchers used the TriNetX research network to identify adults with Crohn’s disease and overweight or obesity who either started a GLP-1 receptor agonist or had no exposure. Patients were matched 1:1 using propensity scores to balance demographics, comorbidities, prior inflammatory bowel disease treatments, healthcare use, and baseline steroid exposure.
 
After matching, the analysis included 546 GLP-1 receptor agonist users and 546 non-users with similar baseline characteristics. Over 12 months, steroid dependence was significantly lower among GLP-1 users compared with nonusers (52.9% vs 62.8%, respectively).
 
Hospitalizations were also less common in the GLP-1 group (2.3% vs. 3.7%). Time-to-event analyses showed a lower risk of hospitalization and better persistence on advanced Crohn’s therapies among patients receiving GLP-1 treatment (HR 0.74). Rates of major abdominal surgery were similar between groups, with no signal of increased surgical risk.
 
“What stood out most was the consistent association between GLP-1 receptor agonist use and lower steroid dependence,” Dr. Ganju said. “Steroid dependence is something we see commonly in clinical practice and is associated with significant long-term side effects, so seeing a clear reduction was encouraging. We were also reassured by the absence of any signal for increased hospitalization or surgery, which are common concerns with medications that affect gastrointestinal function.”
 
If future studies confirm these results, he added, they could reassure clinicians that GLP-1 receptor agonists can be used safely in certain patients with Crohn’s disease who also have obesity or diabetes.
 
“Rather than avoiding these medications out of concern for worsening gastrointestinal disease, providers may feel more comfortable incorporating them into coordinated care,” Dr. Ganju said. “Importantly, these agents would remain adjunctive and would not replace standard Crohn’s disease therapies.”
He emphasized that prospective trials are still needed to better understand causality, identify which patient subgroups may benefit most, and clarify underlying mechanisms.
 
“As the metabolic profile of patients with Crohn’s disease continues to change, research that bridges inflammatory bowel disease and metabolic health will become increasingly important,” he said.
 
The researchers reported having no relevant disclosures.

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