(218) Evaluating the Association Between GLP-1 RA Prescriptions and New-Onset Dysphagia: A Population-Based Cohort Study

Introduction: Since their expanded FDA approval for weight loss in 2014, use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) has increased and been associated with various otolaryngologic side effects. Their effects on gastric emptying, gastroesophageal reflux, and muscle loss raise concerns about dysphagia and aspiration, leading perioperative guidelines to recommend temporary discontinuation before general anesthesia. However, the relationship between GLP-1 RAs and dysphagia or aspiration outside the perioperative setting remains unclear.

Methods: This was a propensity-matched cohort analysis of patients with type 2 diabetes mellitus (T2DM) by GLP-1 RA prescription status in the TriNetX platform, a federated research platform with aggregated, de-identified electronic health record data of over 130 million patients worldwide. The index event was T2DM with GLP-1 RA prescription. Propensity score matching was based on age, sex, race, ethnicity, and hyperlipidemia. The primary and secondary outcomes were new-onset dysphagia and aspiration pneumonitis within 1 year of the index event, respectively. Odds ratios with 95% confidence intervals (CI) were reported.

Results: In TriNetX, 1,381,206 and 8,060,814 T2DM patients with and without GLP-1 RA use were available in the database. Following matching, 382,287 patients were in each propensity-matched cohort. There were 9,311 dysphagia events among GLP-1RA users and 11,710 dysphagia events among non-GLP-1RA users for an OR of 0.79 (0.76-0.81). There were 1,474 aspiration pneumonitis events among GLP-1RA users and 3,603 aspiration pneumonitis events among non-GLP-1 RA users for an OR of 0.41 (0.38-0.43). When additionally matching for BMI categories, the OR for dysphagia and aspiration pneumonitis were 0.9 (0.86-0.95) and 0.44 (0.40-0.49), respectively.

Conclusions: GLP-1 RA prescriptions were associated with lower odds of dysphagia and aspiration pneumonitis. Further research is warranted to elucidate this seemingly protective association, including the roles of GLP-1 RA use duration and the extent of weight loss achieved during GLP-1RA therapy.