Abstract Details

Title GLP-1-related Antihyperglycemic Medication Use is Associated with Shorter Survival in Patients with Amyotrophic Lateral Sclerosis and Diabetes Mellitus

Topic Neuromuscular and Clinical Neurophysiology (EMG)

Presentation(s) P11 - Poster Session 11 (8:00 AM-9:00 AM)

Poster/Presentation
Number 11-032

Objective We examined the relationship between glucagon-like-peptide-1 (GLP-1) treatments and disease progression among amyotrophic lateral sclerosis (ALS) patients with diabetes mellitus (DM).

Background GLP-1 agonists and dipeptidyl-peptidase-IV (DPP4) inhibitors increase GLP-1 activity resulting in delayed gastric emptying, decreased appetite, lower blood glucose levels, and weight loss. While these effects might have cardiovascular benefits, their impact on the progression of ALS remains unclear.

Design/Methods An IRB-approved electronic health record search was conducted to identify consecutive patients seen at a single institution from July/2020 to February/2024 with both ALS and DM diagnostic codes. All charts were manually reviewed for demographics, anthropometric measures, disease history, medication use, and tracheostomy/survival. Patients were excluded for not meeting Awaji ALS diagnostic criteria, lacking a documented history of DM, having insufficient records, or presenting to the first ALS clinic with a tracheostomy. Patients were grouped by use of GLP-1 medications (GLP-1 agonists and DPP4 inhibitors). Tracheostomy-free survival was compared between the GLP-1 and no-GLP-1 groups using Kaplan-Meier survival curves and Cox-proportional hazard models adjusted for age, sex, bulbar onset, body mass index (BMI) at diagnosis, and riluzole use.

Results Among the 1,310 ALS patients screened, 85 had confirmed ALS and DM diagnosis, 36 (42%) of whom were treated with GLP-1 medicine(s). Sixty (71%) of the cohort died during follow-up. Age at symptom onset, sex, race, bulbar onset frequency, riluzole use, and BMI were not significantly different between GLP-1 and no-GLP-1 groups. Tracheostomy-free survival from symptom onset was significantly shorter in the GLP-1 group (median survival 31 vs 45 months, p=0.004). After adjusting for covariates, the GLP-1 group was associated with increased mortality compared to the no-GLP-1 group (hazard ratio 3.3, 95% confidence interval [1.7, 6.2], p=0.0003).

Conclusions Treatment with GLP-1-related medications is associated with shorter survival in ALS patients with comorbid DM.

Authors/Disclosures
Ikjae Lee, MD (Columbia University) PRESENTER	Dr. Lee has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Regeneron. The institution of Dr. Lee has received research support from NIH. The institution of Dr. Lee has received research support from Spastic Paraplegia Foundation.
Kathleen Stolwyk, RD	Mrs. Stolwyk has nothing to disclose.
Matthew Harms, MD (Columbia)	Dr. Harms has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Dr. Harms has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Muscular Dystrophy Association. Dr. Harms has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Invitae. Dr. Harms has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Variant Bio. Dr. Harms has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sarepta. Dr. Harms has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amylyx. Dr. Harms has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for uniQure. Dr. Harms has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Littlepage Booth. Dr. Harms has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for O'Connor First. Dr. Harms has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Searcy Denney. Dr. Harms has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Ford, Parshall & Baker LLC . The institution of Dr. Harms has received research support from ALS Association. The institution of Dr. Harms has received research support from Ionis. The institution of Dr. Harms has received research support from ALS Finding a Cure. The institution of Dr. Harms has received research support from Target ALS.
Jinsy Andrews, MD, FAAN (Columbia University Medical Center)	Dr. Andrews has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Dr. Andrews has received personal compensation in the range of $0-$499 for serving as a Consultant for Cytokinetics. Dr. Andrews has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amylyx. Dr. Andrews has received personal compensation in the range of $0-$499 for serving as a Consultant for Regeneron. Dr. Andrews has received personal compensation in the range of $0-$499 for serving as a Consultant for Bristol Meyer Squibb. Dr. Andrews has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for AL-S Pharma. Dr. Andrews has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. Dr. Andrews has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Quralis . Dr. Andrews has received personal compensation in the range of $500-$4,999 for serving as an officer or member of the Board of Directors for Neurosense. Dr. Andrews has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for Akava. The institution of Dr. Andrews has received research support from Amylyx. The institution of Dr. Andrews has received research support from Biogen . The institution of Dr. Andrews has received research support from Cytokinetics . The institution of Dr. Andrews has received research support from NIH . The institution of Dr. Andrews has received research support from Prilenia/Platform Trial . The institution of Dr. Andrews has received research support from ALS Platform Trial . The institution of Dr. Andrews has received research support from Corcept.
Jiyoon Hwang, MPH	Ms. Hwang has nothing to disclose.
Neil A. Shneider, MD, PhD (Columbia University)	Dr. Shneider has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alnylam. Dr. Shneider has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck. Dr. Shneider has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for ProJenX. Dr. Shneider has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Regeneron. Dr. Shneider has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for GLG. Dr. Shneider has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Guidepoint. The institution of Dr. Shneider has received research support from Merck Sharp & Dohme. The institution of Dr. Shneider has received research support from National Institutes of Health. The institution of Dr. Shneider has received research support from ALS Association. The institution of Dr. Shneider has received research support from DoD/CDMRP - ALSRP. The institution of Dr. Shneider has received research support from Target ALS. The institution of Dr. Shneider has received research support from Ionis Pharmaceutical. The institution of Dr. Shneider has received research support from Cellenkos.

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