Pathways to Sustainable GLP-1 Receptor Agonist Off-Ramping

To the Editor The Viewpoint by Manne-Goehler et al on developing a sustainable pathway for obesity care with glucagon-like peptide-1 receptor agonists (GLP-1RAs) is timely and addresses a critical issue for the future of effective obesity management. This article highlights the urgent need to explore not only the coverage and optimal treatment duration for GLP-1RAs but also strategies for off-ramping, defined as “the tapering or withdrawal of a GLP-1RA after [the optimal] treatment period and its replacement by an alternative approach to weight maintenance.” The authors propose a research agenda focused on studying safe off-ramping strategies, including approaches that integrate a Food is Medicine approach, define the optimal duration of GLP-1RA therapy before off-ramping, explore broader health and metabolic implications of off-ramping, and identify factors that predict successful transitions and long-term maintenance of outcomes for patients.

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Marzo 2025

Definite benefits of GLP-1 receptor agonists: what is the risk of gastroparesis and lung aspiration?

Introduction: multiorgan system benefits of GLP-1 receptor agonists Recently, there have been several important contributions published in GUT on the role of glycaemic control and glucagon-like peptide-1 (GLP-1) receptor agonists (RAs) in diverse gastrointestinal diseases. First, there was a reduction of 10-year risk of major adverse liver outcomes (MALO), that is, decompensated cirrhosis, hepatocellular carcinoma, liver transplantation or MALO-related death, based on Swedish healthcare registers (2010–2020). The study compared GLP-1 RA initiators to non-initiators among patients with chronic liver disease and type 2 diabetes (T2D).1 The best benefit was observed for those documented to have continued GLP-1 RAs, but it was not significant for GLP-1 RA initiators without continued use. A published commentary discussed the complexity of the study design and analysis and questioned the real-world applicability of the data.2 Second, the potential benefit of a holistic approach to the treatment of metabolic dysfunction-associated…

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Febbraio 2025