Abstract 4357452: Glucagon-Like Peptide-1 Receptor Agonists Show Varied Impact on Venous Thromboembolism Risk: A Comprehensive Bayesian Network Meta-Analysis of Randomized Controlled Trials

Abstract

Background: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly used in diabetes management, but their association with venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), remains unclear. Research Questions: We sought to determine whether glucagon-like peptide-1 receptor agonists (GLP-1RAs) significantly increase venous thromboembolism (VTE) risk compared to placebo or other anti-diabetic drugs. Methods: A systematic search of PubMed, SCOPUS, and EMBASE was conducted for RCTs comparing GLP-1RAs (dulaglutide, lixisenatide, exenatide, semaglutide, albiglutide, liraglutide) with placebo or other anti-diabetic drugs, reporting DVT and PE outcomes. A Bayesian network meta-analysis was performed to estimate odds ratios (OR) with 95% credible intervals (CrI) using Markov Chain Monte Carlo (MCMC) methods, and convergence was evaluated through the Gelman-Rubin diagnostic. Surface under the cumulative ranking curve (SUCRA) ranked treatments by efficacy. Results: From 39 RCTs with 70,499 participants, GLP-1RAs showed varied risks. For VTE versus control: dulaglutide (OR: 1.63, 95% CrI: 0.05 to 8.45; SUCRA: 65.23%), lixisenatide (OR: 3.66, 95% CrI: 0.03 to 20.47; SUCRA: 61.02%), exenatide (OR: 5.75, 95% CrI: 0.03 to 30.48; SUCRA: 53.77%), semaglutide (OR: 1.59, 95% CrI: 0.28 to 5.82; SUCRA: 50.51%), albiglutide (OR: 3.48, 95% CrI: 0.19 to 16.31; SUCRA: 33.95%), liraglutide (OR: 6.15, 95% CrI: 0.31 to 34.48; SUCRA: 29.15%), control (SUCRA: 56.38%). For DVT versus control: dulaglutide (OR: 1.24, 95% CrI: 0.02 to 6.82; SUCRA: 79.04%), lixisenatide (OR: 8.08, 95% CrI: 0.05 to 45.38; SUCRA: 49.66%), albiglutide (OR: 5.49, 95% CrI: 0.19 to 29.58; SUCRA: 38.77%), liraglutide (OR: 12.28, 95% CrI: 0.21 to 69.73; SUCRA: 33.24%), semaglutide (OR: 5.11, 95% CrI: 0.41 to 24.78; SUCRA: 33.07%), control (SUCRA: 66.23%). For PE versus control: lixisenatide (OR: 0.94, 95% CrI: 0.03 to 3.15; SUCRA: 82.64%), exenatide (OR: 1.28, 95% CrI: 0.05 to 5.91; SUCRA: 62.62%), semaglutide (OR: 0.88, 95% CrI: 0.28 to 2.15; SUCRA: 60.08%), liraglutide (OR: 1.45, 95% CrI: 0.33 to 5.06; SUCRA: 43.99%), dulaglutide (OR: 1.48, 95% CrI: 0.24 to 5.03; SUCRA: 43.58%), control (SUCRA: 44.71%), albiglutide (OR: 4.10, 95% CrI: 0.57 to 16.20; SUCRA: 12.38%). Conclusions: GLP-1RAs exhibit varied VTE risks, with liraglutide showing the highest risk for VTE, and albiglutide for PE. Dulaglutide and lixisenatide appear safer for DVT and PE, respectively.