Prevention of biliary diseases associated with GLP-1 receptor agonist therapy

Background. In recent years, glucagon-like peptide-1 receptor agonists (GLP-1a) have emerged as pivotal therapeutic agents in the management of metabolic disorders, particularly type 2 diabetes mellitus and obesity. This is due to their ability to improve glycemic control and facilitate weight loss by enhancing insulin secretion, suppressing glucagon release and delaying gastric emptying by promoting prolonged satiety and reducing appetite. However, despite their clinical efficacy, therapy with GLP-1RAs has been associated with an increased risk of gallbladder disease, especially with prolonged use and higher doses. Objective. The aim of this study is to evaluate current clinical data regarding the incidence and severity of adverse effects involving gallbladder and biliary tract in patients receiving GLP-1αtherapy, to evaluate potential prevention strategies and to assess the efficacy of ursodeoxycholic acid (UDCA) in this patient population. The objective of this review is to examine the potential mechanisms through which GLP-1 receptor agonists may contribute to the development of biliary tract diseases. Recent systematic reviews, meta-analyses and Randomized Controlled Trials (RCTs) indicate an increased risk of gallbladder and biliary tract diseases with GLP-1 receptor agonist therapy. The risk is highest with high-dose and long-term therapy, as well as in patients treated for weight loss and type 2 diabetes mellitus (T2DM). The increased risk of gallbladder diseases associated with GLP-1 receptor agonists therapy has important clinical implications necessitating careful monitoring of the gallbladder and biliary tract before initiation, as well as of patients receiving GLP-1 receptor agonist therapy. UDCA positively affects choleresis, reduces the inflammation and improves metabolic parameters; therefore, it is recommended for the prevention and treatment of adverse events associated with GLP-1 receptor agonist therapy.