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. 2022 Dec 24;12(1):145.
doi: 10.3390/jcm12010145.

Clinical Recommendations to Manage Gastrointestinal Adverse Events in Patients Treated with Glp-1 Receptor Agonists: A Multidisciplinary Expert Consensus

Juan J Gorgojo-Martínez  1 , Pedro Mezquita-Raya  2 , Juana Carretero-Gómez  3 , Almudena Castro  4 , Ana Cebrián-Cuenca  5 , Alejandra de Torres-Sánchez  2 , María Dolores García-de-Lucas  6 , Julio Núñez  7 , Juan Carlos Obaya  8 , María José Soler  9 , José Luis Górriz  10 , Miguel Ángel Rubio-Herrera  11
Affiliations

Clinical Recommendations to Manage Gastrointestinal Adverse Events in Patients Treated with Glp-1 Receptor Agonists: A Multidisciplinary Expert Consensus

Juan J Gorgojo-Martínez et al. J Clin Med. .

Abstract

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are indicated in type 2 diabetes and obesity for their high efficacy in controlling glycaemia and inducing body weight loss, respectively. Patients may develop gastrointestinal adverse events (GI AEs), namely nausea, vomiting, diarrhoea and/or constipation. To minimize their severity and duration, healthcare providers (HCPs) and patients must be aware of appropriate measures to follow while undergoing treatment. An expert panel comprising endocrinologists, nephrologists, primary care physicians, cardiologists, internists and diabetes nurse educators convened across virtual meetings to reach a consensus regarding these compelling recommendations. Firstly, specific guidelines are provided about how to reach the maintenance dose and how to proceed if GI AEs develop during dose-escalation. Secondly, specific directions are set about how to avoid/minimize nausea, vomiting, diarrhoea and constipation symptoms. Clinical scenarios representing common situations in daily practice, and infographics useful to guide both HCPs and patients, are included. These recommendations may prevent people with T2D and/or obesity from withdrawing from GLP-1 RAs treatment, thus benefitting from their superior effect on glycaemic control and weight loss.

Keywords: gastrointestinal adverse events; glucagon-like peptide-1 receptor agonists; guidelines; obesity; type 2 diabetes.

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Conflict of interest statement

Juan J. Gorgojo-Martínez has the following financial relationships: advisor on scientific boards for Astra-Zeneca, Janssen Pharmaceuticals, Eli Lilly and Company, Merck Sharp & Dohme and Novo-Nordisk; lectures for Abbott, AbbVie Inc, Amarin, Astra-Zeneca, Boehringer Ingelheim Pharmaceuticals Inc, Esteve, Janssen Pharmaceuticals, Eli Lilly and Company, Merck Sharp & Dohme, Mundipharma, Novo-Nordisk and Roche Pharma, and research activities for Astra-Zeneca, Mundipharma, Novo-Nordisk and Eli Lilly and Company. Pedro Mezquita-Raya has the following financial relationships: advisor on scientific boards for Abbott, Astra-Zeneca, FAES and Novo-Nordisk; lectures for Astra-Zeneca, Eli Lilly and Company, FAES, Fresenius and Novo-Nordisk and research activities for Eli Lilly and Company and Novo Nordisk. Juana Carretero-Gómez reported receiving consulting fees and/or speaker from Astra Zeneca, Boehringer-Ingelheim, Janssen, MSD, Abbot, Nestle, Sanofi-Aventis and Novo-Nordisk. Almudena Castro has consulting fees from Astra Zeneca, Novartis, Boehringer-Ingelheim, Lilly, Novo-Nordisk, Bayer, Pfizer, Amgen, Sanofi, Organon, Daichii Sankyo and Vifor Pharma. Ana Cebrián-Cuenca has the following financial relationships: advisor on scientific boards for Astra-Zeneca, Boehringer Ingelheim Pharmaceuticals Inc, Eli Lilly and Company, Merck Sharp & Dohme and Novo-Nordisk; lectures for Astra-Zeneca, Boehringer Ingelheim Pharmaceuticals Inc, Esteve, Janssen Pharmaceuticals, Eli Lilly and Company, Merck Sharp & Dohme, Mundipharma and Novo-Nordisk, and research activities for Astra-Zeneca, Merck Sharp & Dohme, Mundipharma, Novo-Nordisk and Eli Lilly and Company. Alejandra de Torres has the following financial relationships: lectures for Novo-Nordisk, received grant support from Abbott, and research activities from Novo-Nordisk and Eli Lilly and Company. María Dolores García de Lucas has the following financial relationships: advisor on scientific boards for Boehringer Ingelheim Pharmaceuticals Inc and Novo-Nordisk; lectures for Astra-Zeneca, Boehringer Ingelheim Pharmaceuticals Inc, Janssen Pharmaceuticals, Eli Lilly and Company, Merck Sharp & Dohme, Mundipharma and Novo-Nordisk. Julio Núñez reports personal and consulting fees from Astra Zeneca, Novartis, Boehringer-Ingelheim, Eli Lilly, Rovi, Novo-Nordisk, Bayer, Pfizer, and Vifor Pharma. Juan Carlos Obaya has the following financial relationships: advisor on scientific boards for, Astra-Zeneca, Novo-Nordisk and Novartis; lectures for Astra-Zeneca, Eli Lilly and Company, Ferrer, Sanofi and Novo-Nordisk. María José Soler is the CKJ Editor-in-Chief and reports honorarium for conferences, consulting fees and advisory boards from AstraZeneca, Novo-Nordsik, Esteve, Vifor, Travere Therapeutics, Bayer, Mundipharma, Ingelheim Lilly, Jansen, ICU Medical and Boehringer. José Luis Górriz has the following financial relationships: advisor on scientific boards for Astra-Zeneca, Bayer and Novo-Nordisk; lectures for Astra-Zeneca, Boehringuer-Ingelnheim, Esteve, Bayer, Eli Lilly and Company, Mundipharma, Astrazeneca, Novartis, Bayer, Astellas and Novo-Nordisk and research activities for Astra-Zeneca. Miguel Ángel Rubio-Herrera reported receiving consulting fees and/or speaker from Amgen, Astra Zeneca, Boehringer-Ingelheim, Eli Lilly, Janssen, Merck, Mundipharma, Rubió, and Sanofi-Aventis; and is an advisory board member and speaker for Novo-Nordisk.

Figures

Figure 1
Figure 1
Minimizing occurrence/severity of GI AEs: patients general guidelines.
Figure 2
Figure 2
Additional specific guidelines for each separate GI AE.
Figure 3
Figure 3
Additional specific guidelines for unusually severe/persistent GI AEs.
Figure 4
Figure 4
Minimizing occurrence/severity of GI AEs: the role of HCPs.
See this image and copyright information in PMC

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