GLP-1 RAs Safe Months After Kidney Transplant

SEATTLE -- Even for new kidney transplant recipients with diabetes, GLP-1 receptor agonists (RAs) were safe and effective, a researcher reported here.

In a retrospective study, kidney transplant patients who were on insulin with or without other oral antidiabetic medications when they started a GLP-1 RA were able to significantly cut back on their total daily insulin dose requirements, said Mario Campana, MD, of the University of Alabama at Birmingham.

These patients were able to drop down to an average daily dose of 56.13 units of insulin 6 months after starting a GLP-1 RA from a baseline daily dose of 61.28 units, he said during a presentation at the American Association of Clinical Endocrinology (AACE) annual meeting.

In comparison, kidney transplant patients who didn't start a GLP-1 RA increased their daily dose from 34.03 units to 41.65 units.

GLP-1 RA users also lost a few pounds after 6 months of treatment (204.17 lb from 206.04 lb at baseline), while those not on these agents gained a significant amount of weight (180.96 lb at baseline to 188.61 lb after 6 months).

Models were adjusted for race, GLP-1 RA type, BMI, insulin type, and time for the outcome, said Campana.

And even in this vulnerable kidney population, glomerular filtration rate (GFR) increased with GLP-1 RA use for 6 months: 50.48 at baseline to 53.44 mL/min/ 1.73m². Meanwhile, GFR dropped from 43.40 down to 40.84 mL/min/ 1.73m² for non-users. Creatinine also remained stable in the GLP-1 RA group (1.50 vs 1.48 mg/dL at 6 months) versus an uptick in non-GLP-1 RA users (2.20 vs 2.74 mg/dL at 6 months).

"This is the message I want you to take home, guys," said Campana. "The GLP-1 RA actually showed statistically preserved GFR and creatinine levels compared to the control group. That shows that GLP-1 RAs are safe in [the] kidney transplant population."

Tacrolimus level variability wasn't found to be significantly different between the groups.

"This is also important," he continued. "That shows that, if you select carefully the correct patients to start [a GLP-1 RA], we don't expect to have these side effects."

There also weren't any significant differences noted between the groups in terms of HbA1c, fructosamine, glucose management indicator, time spent in range, and time spent below range. But in GLP-1 RA users, HbA1c, fructosamine, and time spent below range all went down, while time spent in range went up.

The analysis included 50 adults who underwent kidney transplantation who had either a history of type 2 diabetes (56%) or post-transplant diabetes (44%). A common outcome from organ transplantation, post-transplant diabetes is known to occur in roughly 30% of renal transplant recipients. Half added a GLP-1 RA to their existing regimen of insulin with or without an oral antidiabetic medication (either a glipizide, SGLT2 inhibitor, or DPP-4 inhibitor) and half were not put on one of these agents.

A total of 88% of patients put on a GLP-1 RA were on it for the first time. This group initiated an agent an average of 7.72 months after transplantation.

Campana noted that about 80% were put on semaglutide (Ozempic) while several others were on dulaglutide (Trulicity). "We didn't find any difference [between GLP type], so it doesn't matter which GLP-1 type to use," he noted.

Because of the known gastrointestinal side effects with GLP-1 RAs, Campana said patients with a history or active symptoms of gastroparesis were excluded. Those with a history of pancreatitis, gallbladder stones, and a family or person history of medullary or thyroid C cell carcinoma were also excluded.

No patients on a GLP-1 RA discontinued treatment and none developed any significant gastrointestinal side effects. Patients on one of these agents were instructed to eat small meal portions.

The average age was 56, 64% were men, and 60% were Black patients. Nearly all were on steroids, and all were on calcineurin inhibitors at baseline.

Campana added that his group is continuing research on GLP-1 RA and dual agents in post-transplant patients, "especially in the early post-transplant period ... when it's really important to manage the metabolic risk," he said.

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