GLP-1 agonists: A review for emergency clinicians

Therapeutic peptides: chemical strategies fortify peptides for enhanced disease treatment efficacy

Therapeutic peptides, as a unique form of medication composed of orderly arranged sequences of amino acids, are valued for their high affinity, specificity, low immunogenicity, and economical production costs. Currently, more than 100 peptides have already secured market approval. Over 150 are actively undergoing clinical trials, while an additional 400-600 are in the preclinical research stage. Despite this, their clinical application is limited by factors such as salt sensitivity, brief residence in the bloodstream, inadequate cellular uptake, and high structural flexibility. By employing suitable chemical methods to modify peptides, it is possible to regulate important physicochemical factors such as charge, hydrophobicity, conformation, amphiphilicity, and sequence that affect the physicochemical properties and biological activity of peptides. This can overcome the inherent deficiencies of peptides, enhance their pharmacokinetic properties and biological activity, and promote continuous progress in the field of research. A diverse array of modified peptides is currently being developed and investigated across numerous therapeutic fields. Drawing on the latest research, this review encapsulates the essential physicochemical factors and significant chemical modification strategies that influence the properties and biological activity of peptides as pharmaceuticals. It also assesses how physicochemical factors affect the application of peptide drugs in disease treatment and the effectiveness of chemical strategies in disease therapy. Concurrently, this review discusses the prospective advancements in therapeutic peptide development, with the goal of offering guidance for designing and optimizing therapeutic peptides and to delve deeper into the therapeutic potential of peptides for disease intervention.

An overview of the non-procedural treatment options for peripheral neuropathic pain

Peripheral neuropathic pain is common in patients with peripheral nerve injury and can significantly impact both their function and quality of life. There is a wide variety of non-interventional treatment approaches, including pharmacologic therapy, physical/occupational therapy, modalities (therapeutic, mechanical, thermal, etc.), psychology, and lifestyle modification. First line pharmacologic therapy for peripheral neuropathic pain includes gabapentinoids, tricyclic antidepressants, and serotonin-norepinephrine reuptake inhibitors. Other classes of medications, such as topical treatments, opioids, and cannabinoids, have more limited usefulness in treatment but remain part of a treatment regimen. Physical and occupational therapy, psychological interventions, and lifestyle medicine are important adjuncts in the treatment and prevention of future peripheral neuropathic pain. The strength of the evidence supporting each intervention varies, with that for pharmacologic intervention being the strongest. A combination of these options tailored to the individual needs of the patient likely will result in the best treatment outcome for peripheral neuropathic pain.

Association between various dosage forms of semaglutide and ocular adverse events in a real-world setting

BACKGROUND

This study systematically compares the risk of long-term ocular adverse events between subcutaneous and oral semaglutide preparations to assess pathway-specific safety differences.

METHODS

In this study, the Report odds ratio (ROR) technique was employed to detect signals of adverse drug reactions (ADRs) associated with the use of semaglutide. Analysis was conducted on data extracted from the FDA Adverse Event Reporting System (FAERS) database, covering the period from 2004(Q1) through 2024(Q3). This investigation encompasses a descriptive analysis focused on the administration of semaglutide through various routes, encompassing a broad range of demographics including gender (male and female), age groups, along with other demographic data and the timing of disease onset. Following this, the study employs the ROR methodology to assess the differential adverse event signals across distinct semaglutide formulations.

RESULTS

We categorized the eye as the System Organ Class (SOC) and obtained 1733 ADE reports related to it from the FAERS database. Of these, 1541 reports were associated with injectables, while tablets were linked to 192 ADE reports. In both dosage forms, most cases occurred within the first month of administration, although the median time to onset (TTO) differed, with injectables identified at 7.00 [IQR 0.00-56.00] days and tablets at only 3.50 [IQR 0.00-35.00] days. It is worth noting that 5.41% of patients administered subcutaneous injections and 2.17% of those receiving oral medications reported ADEs following one year of treatment with semaglutide. Furthermore, female patients exhibited a higher susceptibility to ocular adverse reactions compared to their male counterparts. Regarding the primary preferred terms (PTs), blurred vision constitutes 34.33% of the total ADEs associated with tablet formulations. This incidence is marginally higher than that observed with injectable formulations. This investigation further discerned ocular ADEs signals associated with specific formulations: subcutaneous injections have a higher frequency of reports concerning retinal complications, such as diabetic retinopathy, ischemic optic neuropathy, retinal detachment, retinal tear, and retinal hemorrhage.

CONCLUSION

The results of this study identified a significant difference between subcutaneous and oral semaglutide in ocular ADE risk, providing some evidence for dosage form selection and risk monitoring for clinical use.

A Closer Look at the Dermatological Profile of GLP-1 Agonists

BACKGROUND/OBJECTIVES

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are widely used in treating type 2 diabetes and obesity, offering established metabolic and cardiovascular benefits. Emerging evidence suggests these agents also exert direct dermatologic effects. This systematic review categorizes these effects and explores their role in inflammatory skin diseases.

METHODS

A comprehensive literature search was performed across EMBASE, PubMed, Web of Science, and Google Scholar for studies published from 2014 to 2025. Inclusion criteria were English-language, peer-reviewed original research involving human subjects that linked GLP-1RAs to dermatologic effects. Animal and in vitro studies were excluded. PRISMA guidelines were followed.

RESULTS

Fifty-one studies met inclusion criteria. Thirty-four reported adverse effects, including hypersensitivity, injection-site reactions, pruritus, urticaria, angioedema, and immune-mediated conditions like bullous pemphigoid. Seventeen studies described beneficial outcomes, such as improvements in psoriasis, reduced hidradenitis suppurativa flares, enhanced wound healing, anti-aging potential, and decreased inflammation. GLP-1RAs showed cytokine modulation in psoriasis, though their role in hidradenitis suppurativa remains uncertain. Cosmetic concerns, such as "Ozempic Face" due to rapid weight loss, were also noted.

CONCLUSIONS

GLP-1RAs have a broad spectrum of dermatologic effects, from immunomodulatory benefits to adverse cutaneous reactions. Their impact on inflammatory skin disorders suggests a novel therapeutic avenue. However, adverse reactions and aesthetic changes warrant vigilance. Future research should focus on mechanistic studies, long-term safety, and identifying biomarkers to predict dermatologic responses, ultimately guiding personalized treatment approaches.

Knowledge, attitude and practice toward liraglutide and semaglutide among endocrinology medical staff

Semaglutide and liraglutide are commonly used to address metabolic disorders, but differ in usage, clinical efficacy and safety profiles. Endocrinology medical staff are crucial in ensuring the appropriate administration, but their knowledge, attitude, and practice (KAP) towards these medications have been underexplored. The study aimed to investigate their KAP toward liraglutide and semaglutide. A cross-sectional study was performed from September to December 2023 at the First People's Hospital of Jiujiang. Endocrinology medical staff completed a self-administered questionnaire for KAP assessment regarding liraglutide and semaglutide. A total of 265 participants were enrolled (mean age: 36.31 ± 8.17 years old), including 134 (50.57%) males. The average scores were as follows: knowledge 11.77 ± 3.37 (range: 0-16), attitude 39.30 ± 4.61 (range: 10-50), and practice 27.70 ± 5.52 (range: 7-35). The structural equation model (SEM) showed that knowledge significantly influenced attitude (β = 0.976, P < 0.001) and practice (β = 1.289, P < 0.001). Additionally, attitude had a significant effect on practice (β = 0.627, P < 0.001). This study revealed deficiencies in the KAP scores among endocrinology medical staff, emphasizing the necessity for targeted strategies to improve professional proficiency with liraglutide and semaglutide.

A Case of Intussusception With Bowel Obstruction in a Gastric Roux-en-Y Patient Prescribed Semaglutide

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly prescribed for glycemic control and weight loss management in type 2 diabetes. Their use, however, is associated with a wide range of gastrointestinal adverse effects like nausea, vomiting, and abdominal discomfort. This case report presents a 59-year-old woman with a previous Roux-en-Y gastric bypass who was prescribed semaglutide, and subsequently developed intussusception with small bowel obstruction and chemical pancreatitis. The patient presented to the emergency department with nausea, vomiting, and epigastric pain. The patient's laboratory and radiographic studies revealed a long segment of small bowel intussusception, resulting in a small bowel obstruction and likely chemical pancreatitis. Laparoscopic surgical intervention was required, ultimately converted to a laparotomy for successful reduction of the intussusception. This case report underscores a potential complication that may be seen in patients prescribed GLP-1RAs with prior gastric Roux-en-Y surgeries. The adverse effect is likely attributable to altered gastrointestinal motility and delayed gastric emptying, mechanisms that may be exacerbated by the combination of bariatric-induced anatomical changes and the pharmacological actions of GLP-1RAs. Given the increasing prevalence of GLP-1RA use, emergency medicine clinicians must remain vigilant for these potential serious adverse effects, particularly in patients with complex gastrointestinal histories to ensure timely diagnosis and intervention.

Pancreatitis Risk Associated with GLP-1 Receptor Agonists, Considered as a Single Class, in a Comorbidity-Free Subgroup of Type 2 Diabetes Patients in the United States: A Propensity Score-Matched Analysis

Introduction: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are commonly prescribed for the management of type 2 diabetes mellitus (T2DM). However, the potential connection between GLP-1 RAs and the risk of pancreatitis presents a complex and nuanced issue. Although these drugs are effective in improving blood sugar control and cardiovascular health, their association with pancreatitis remains an area of concern. Our study aims to evaluate the association between the use of GLP-1 RAs, considered as a single class, and the risk of pancreatitis in a comorbidity-free subgroup of patients with type 2 diabetes mellitus (T2DM) in the United States. Methods: Data were retrieved from the TriNetX research database using the US Collaborative Network, which included information from 61 healthcare organizations within the U.S. Patients diagnosed with T2DM were categorized into two cohorts: one consisting of the patients prescribed with GLP-1 RAs and the other comprising patients who did not receive GLP-1 RAs. Of this class of medications, the agents analyzed were dulaglutide, lixisenatide, exenatide, liraglutide, and semaglutide. Using a 1:1 propensity score matching (PSM) model, we matched patients of both cohorts based on baseline demographics, comorbidities (hypertensive disorders, ischemic heart disease, gallstones, annular pancreas, alcohol use disorders, hypertriglyceridemia, hypercalcemia, cystic fibrosis, and cannabis use), medications known to cause drug-related pancreatitis, and laboratory values. Results: Of 969,240 patients with T2DM, 9.7% (93,608) were on GLP-1 RA, and 90.3% (875,632) were not. After PSM, the sample included 81,872 patients in each cohort. The risk of pancreatitis between the two groups was not statistically different between the two cohorts at 6 months at (0.1% vs. 0.1%, p = 0.04), and remained without significant increase with time; at 1 year (0.1% vs. 0.2%, p = 0.02), 3 years (0.2% vs. 0.3%, p = 0.001), and 5 years (0.3% vs. 0.4%, p < 0.001). The lifetime risk of developing pancreatitis in patients on GLP-1 RA was lower (0.3% vs. 0.4%, p < 0.001). Conclusions: In our comorbidity-free U.S.-based population with T2DM, the use of GLP-1 RAs did not increase their risk of pancreatitis. Their use was associated with a lower lifetime risk of pancreatitis.

Influence of glucagon-like peptide-1 receptor agonists on hepatic events in type 2 diabetes: a systematic review and meta-analysis

BACKGROUND AND AIM

Type 2 diabetes mellitus (T2DM) is intrinsically linked to various etiologies of liver disease, with 69% of patients having concomitant metabolic dysfunction-associated steatotic liver disease (MASLD). Studies suggest glucagon-like peptide-1 receptor agonists (GLP-1RAs) can ameliorating liver disease. With this analysis, we address the gap in knowledge about the effectiveness of these agents in preventing different major adverse liver outcomes (MALOs).

METHODS

PubMed, Embase, and The Cochrane Central of Trials were searched for articles reporting MALOs in T2DM patients. Publication bias-identifying methods, quality assessment and sensitivity analyses (subgroup analyses, leave-one-out meta-analyses, and meta-regression) were employed. Statistical analyses were performed in R using the "meta" and "metafor" packages.

RESULTS

Nine cohort studies from 535 identified articles encompassing 579 256 T2DM patients were included in the main analyses. GLP-1RA use was associated with reduced risks of hepatocellular carcinoma (HR 0.74, 95% CI 0.56-0.96) and cirrhosis decompensation (HR 0.68, 95% CI 0.65-0.72). Within the latter, variceal bleeding and hepatic encephalopathy prevention were found to be significantly reduced. Egger's test, Begg's test, and funnel-plot analysis yielded no publication bias. No significant differences were observed in preventing cirrhosis or hepatic failure. Meta-regression analysis revealed a positive correlation between hepatocellular carcinoma incidence and both male sex and longer follow-up duration.

CONCLUSIONS

This meta-analysis improves our understanding of the hepatoprotective effects of GLP-1RAs in T2DM patients and supports existing research, exhibiting superiority over other antidiabetic medications for hepatoprotection in this subgroup. Additional long-term follow-up studies are necessary to further validate these findings.

Guidance on Preoperative Management of Hand Surgery Patients Taking GLP-1 Receptor Agonists

Glucagon-like peptide-1 (GLP-1) receptor agonists are medications used to treat type 2 diabetes and may aid in weight loss efforts. The surgical management of patients taking GLP-1 agonists differs from others due to the slowed gastric emptying effects of GLP-1 medications. Patients taking these medications may have a higher risk of pulmonary aspiration during hand surgery than other patients, which affects their presurgical management. This article reviews GLP-1 agonists and their role in diabetes and weight loss, as well as current recommendations for surgical management of patients taking GLP-1 agonists.

Glucagon-Like Peptide 1 Receptor Agonists Are Not Associated With an Increased Risk of Ileus or Intestinal Obstruction in Patients with Inflammatory Bowel Disease-A Danish Nationwide Cohort Study

BACKGROUND

There is a global increase in the prevalence of obesity, including among individuals with inflammatory bowel disease (IBD). Glucagon-like peptide 1 receptor agonists (GLP-1RAs) are potential anti-obesity medications due to their weight-lowering effects. However, concerns exist regarding ileus and intestinal obstruction as a severe side effect.

METHODS

This nationwide Danish cohort study evaluates the risk of ileus and intestinal obstruction in patients with IBD receiving GLP-1RAs. Patients with IBD and their exposure to GLP-1RAs were identified using Danish health registries. Cox regression analysis was used to estimate hazard ratios for the risk of ileus and intestinal obstruction adjusted for age at diagnosis of IBD, sex, type of IBD, prior ileus or intestinal obstruction, diabetes status, steroid use, and small bowel or colon surgery.

RESULTS

This study found that GLP-1RA exposure was not associated with an increased risk of ileus or intestinal obstruction in patients with IBD.

CONCLUSION

This study suggests that GLP-1RAs do not increase the risk of ileus or intestinal obstruction in patients with IBD.

Amiodarone Therapy: Updated Practical Insights

Amiodarone, a bi-iodinated benzofuran derivative, is among the most commonly used antiarrhythmic drugs due to its high level of effectiveness. Though initially categorized as a class III agent, amiodarone exhibits antiarrhythmic properties across all four classes of antiarrhythmic drugs. Amiodarone is highly effective in maintaining sinus rhythm in patients with paroxysmal atrial fibrillation while also playing a crucial role in preventing a range of ventricular arrhythmias. Amiodarone has a complex pharmacokinetic profile, characterized by a large volume of distribution and a long half-life, which can range from several weeks to months, resulting in prolonged effects even after discontinuation. Side effects may include thyroid dysfunction, pulmonary fibrosis, and hepatic injury, necessitating regular follow-ups. Additionally, amiodarone interacts with several drugs, including anticoagulants, which must be managed to prevent adverse effects. Therefore, a deep understanding of both oral and intravenous formulations, as well as proper dosage adjustments, is essential. The aim of this paper is to provide a comprehensive and updated review on amiodarone's indications, contraindications, recommended dosages, drug interactions, side effects, and monitoring protocols.

Pharmacovigilance study of GLP-1 receptor agonists for metabolic and nutritional adverse events

Aims: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are employed extensively in the management of type 2 diabetes and obesity. However, there is a paucity of real-world data on their safety and tolerability for metabolic and nutritional adverse events in large sample populations. This study aimed to analyse the metabolic and nutritional safety signatures of different GLP-1 RAs by exploring the Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS). Methods: AEs data were extracted from the FDA Adverse Event Reporting System database for each GLP-1 RA from the time of its launch until the second quarter of 2023. The reported odds ratio (ROR), proportional reporting ratio (PRR), Empirical Bayesian Geometric Mean and Bayesian Confidence Propagation Neural Network were employed to identify AE signals. Results: A system organ class of metabolism and nutrition disorders was employed to filter AE reports, resulting in the identification of 10,450 reports for exenatide, 2,860 reports for liraglutide, 240 reports for albiglutide, 4,847 reports for dulaglutide, 2,905 reports for semaglutide, 1,089 reports for tirzepatide, and 13 reports for lixisenatide. Semaglutide (ROR, 3.34; 95%CI, 3.22), liraglutide (ROR, 2.78; 95%CI, 2.69), and exenatide (ROR, 2.15; 95%CI, 2.11) were associated with metabolism and nutrition disorders. The number of AE signals detected were as follows: albiglutide (n = 1), lixisenatide (n = 2), tirzepatide (n = 11), exenatide (n = 12), liraglutide (n = 16), semaglutide (n = 20), dulaglutide (n = 22). Dehydration was the most frequent AE contributing to serious outcomes for liraglutide (n = 318, 23.93%), dulaglutide (n = 434, 20.90%), semaglutide (n = 370, 25.10%) and tirzepatide (n = 70, 32.86%). The time to onset (TTO) of AE was statistically different between exenatide and the other GLP-1 RAs (p < 0.001), and the Weibull parameters for dehydration for liraglutide, dulaglutide, and semaglutide analyses all showed an early failure-type profile. Conclusion: Our study suggests that exenatide, liraglutide, and semaglutide are more susceptible to metabolic and nutritional AEs than other GLP-1 RAs. Liraglutide, dulaglutide, semaglutide, and tirzepaptide's potential to induce dehydration, necessitates special attention. Despite certain deficiencies, GLP-1 RAs have considerable potential for the treatment of eating disorders.