Liraglutide better than standard of care for bile acid diarrhea, small trial claims

Denmark: Diabetes drug liraglutide is superior to colesevelam for reducing stool frequency prompting researchers to suggest considering liraglutide as a potential new treatment modality for bile acid diarrhea, says a recent study published in The Lancet Gastroenterology & Hepatology. 

Bile acid diarrhea is an underdiagnosed disease that affects about 1–2% of the general population. Case reports have suggested glucagon-like peptide 1 receptor agonist liraglutide to be an effective treatment for bile acid diarrhea. Therefore, Martin L Kårhus, Center for Clinical Metabolic Research, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark, and colleagues aimed to investigate the safety and efficacy of liraglutide for treating bile acid diarrhea in a randomized, double-blind, active-comparator, double-dummy, non-inferiority clinical trial conducted in Denmark. 

The study included patients aged 18–75 years with 75 selenium-homotaurocholic acid test (SeHCAT)-verified moderate-to-severe primary bile acid diarrhea. They were randomly assigned in the ratio of 1:1 to receive liraglutide (one daily subcutaneous injection up titrated from 0·6–1·8 mg per day over 3 weeks) or colesevelam (three capsules of 625 mg twice daily), the standard of care, for 6 weeks following one run-in week with no treatment.

The proportion of participants experiencing a reduction in daily stool frequency of 25% or greater after 6 weeks was the primary endpoint. Data from all participants were included in the analysis of the primary outcome. The non-inferiority limit was set to 15% in favor of colesevelam.