Case Reports
Sunday, October 13, 2024
12:45 PM–02:15 PM
Abstract
Introduction: This case report presents a unique instance of cholelithiasis possibly linked to liraglutide, followed by the safe use of semaglutide and tirzepatide without a cholecystectomy. Recent literature suggests glucagon-like peptide-1 receptor agonists (GLP-1RAs) may increase the risk of gallbladder disease, yet guidance for their use in such patients, particularly those without cholecystectomy, is limited. This underscores the need to better understand these agents' safety profiles to improve risk assessment and patient care.
Case: A 65-year-old black female with type 2 diabetes, on metformin, jardiance, insulin aspart, and insulin glargine, started liraglutide therapy. Despite this, her glycated hemoglobin (HbA1c) worsened (10.4% to 13.9%) and she did not lose weight. After 27 months on liraglutide, she presented with sharp right upper quadrant (RUQ) pain. Imaging revealed cholelithiasis without acute cholecystitis. She declined cholecystectomy, and liraglutide was discontinued. Due to poor glycemic control, semaglutide was initiated 3 months later for 22 months, followed by tirzepatide for 12 months, with no recurrence of gastrointestinal or hepatobiliary symptoms despite cholelithiasis noted in subsequent imaging. Notably, her glycemic control improved (HbA1c decreased to 7.3%) with tirzepatide therapy.
Discussion: This case contrasts existing literature by demonstrating safe and effective GLP-1RA therapy continuation without cholecystectomy, despite active cholelithiasis. Strengths include improved glycemic control with tirzepatide and no further RUQ pain or hepatobiliary symptoms. Limitations stem from scant guidance on initiating or continuing GLP-1RA therapy with active gallbladder disease. A hypothesis could explore whether specific patient characteristics predict favorable outcomes with current gallbladder issues or if certain GLP-1RAs pose higher risks, refining treatment strategies.
Conclusion: This case suggests possible safe continuation of GLP-1RA therapy without cholecystectomy despite cholelithiasis, supporting the conclusion that it could be safe to continue or start GLP-1RA therapy in patients with current gallbladder disease. However, further research is necessary before definitive conclusions can be drawn.
Presenting Author
Angelica Tylka PharmD CandidateUniversity of Illinois at Chicago College of Pharmacy
Authors
Lauren Cunningham PharmD
University of Illinois at Chicago College of Pharmacy