Use of glucagon-like peptide 1 receptor agonists and the associated outcomes in bipolar disorder, from a nationwide cohort, 2009-2024.
M. Taylor1, H. Taipale2, M. Lahteenvuo2, A. taskanen3, E. Mittendorfer-rutz3, J. Tiihonen3
1Griffith University, School of Medicine and Dentistry, Gold Coast, Australia, 2university of eastern finland, School of Medicine, Kuopio, Finland, 3Karolinska, School of Medicine, Stockholm, Sweden
Background: Diabetes, obesity, and bipolar disorder often occur together and may have partly shared pathophysiology. Glucagon-like peptide 1 receptor agonists (GLP-1RA) are widely used for treating diabetes and obesity but their impact on bipolar disorder is unknown.
Aims & Objectives: We studied hospitalisation and absence from work due to sick leave in people already diagnosed with bipolar disorder who were prescribed antidiabetic medications including GLP-1RA.
Method: The study cohort was derived from the national Swedish registers and included all people with a diagnosis of bipolar disorder who used any antidiabetic medication, between the years 2009-2024. GLP-1RA individually and as a group were compared with non-use of GLP-1RA, and directly with other second-line antidiabetic medications. A within-individual design was utilized for all comparisons to reduce confounding. The main outcome was psychiatric hospitalisation for any reason, with secondary outcomes being psychiatric hospitalisation after a relapse of bipolar disorder, and sick leave due to psychiatric reasons. Within-individual stratified Cox models with adjusted Hazard Ratios (aHR) and 95% confidence intervals (CIs) were used.
Results: 14694 people were included in the study, of whom 5200 used GLP-1RA. Semaglutide was associated with a 21% (aHR 0.79, 95% CI 0.69–0.91) lower risk of psychiatric hospitalisation compared to non-use of GLP1-RA. The other individual GLP1-RA were not specifically associated with a lower risk. The corresponding figure for hospitalisation during semaglutide usage for a relapse of bipolar disorder was 17% (aHR 0.83, 95% CI 0.69–0.99). Absences from work due to sick leave were not significantly associated with the specific antidiabetic medications studied.
Discussion & Conclusions: In people with both bipolar disorder and diabetes and/ or obesity, the use of semaglutide was linked to lower rates of psychiatric hospitalisation compared to when GLP-1RA were not being used in the same individual. This association could be further tested in a randomised controlled trial.
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