Safety and efficacy of glucagon-like peptide 1 receptor agonists in solid organ transplant recipients with diabetes mellitus: a systematic review and meta-analysis.

Abstract

There is limited evidence to support the use of glucagon-like peptide-1 receptor agonists (GLP-1RAs) in solid organ transplants (SOTs). This systematic review and meta-analysis aimed to assess the safety and efficacy of GLP-1RAs in this population. PubMed, Embase, and Cochrane databases were a thorough literature search until July 2024 for SOTs with pre- and posttransplant diabetes mellitus (DM). Hemoglobin A1c (HbA1c), weight, and body mass index (BMI) were the primary outcomes. We estimated odds ratios and standardized mean difference (SMD) or mean difference (MD) with 95% confidence interval (CI) for dichotomous and continuous outcomes, respectively. I2 statistics measured heterogeneity. GLP-1RAs were administered to 806 subjects (99.8%) in 16 trials. Median follow-up was 12 months (interquartile range, 1-49 months). The mean age was 57.05 ± 10.24 years, with 64.6% male patients. HbA1c levels (MD, -0.61% [95% CI, -0.82 to -0.40]; p < 0.01, I2 = 72%), weight, and BMI were statistically significantly reduced. Estimated glomerular filtration rate (eGFR; SMD, -0.38 mL/min/1.73 m2 [95% CI, -1.01 to 0.25]; p = 0.24, I2 = 0%), creatinine, and blood pressure did not change significantly. Additionally, total daily insulin dosage, lipid profile, fasting plasma glucose, and urine albumin-to-creatinine ratio and tacrolimus levels (MD, -0.40 ng/mL [95% CI, -0.85 to 0.05]; p = 0.08, I2 = 42%) did not yield statistically significant. GLP-1RAs caused increased nausea and vomiting (13.9%), urinary tract infections (21.1%), and drug discontinuation (13.4%). In SOT recipients, GLP-1RAs significantly reduced HbA1c, weight, and BMI without significantly altering tacrolimus trough levels, eGFR, creatinine, or cardiovascular outcomes. Gastrointestinal side effects were the most common adverse events.