Leki z grupy agonistów receptora GLP-1 u pacjentów z epilepsją: przegląd danych klinicznych, bezpieczeństwa i możliwości terapeutycznych
GLP-1 receptor agonists in people with epilepsy: A scoping review of clinical data, safety, and therapeutic implications
W skrócie
Badacze przeanalizowali dostępne informacje naukowe na temat bezpieczeństwa leków GLP-1 (powszechnie przepisywanych w cukrzycy i otyłości) u osób z epilepsją. Wyniki sugerują, że leki te nie tylko są bezpieczne dla pacjentów z epilepsją, ale mogą nawet zmniejszać ryzyko napadów padaczkowych o 10-57 procent i chronić neurony przed uszkodzeniem. Naukowcy podkreślają, że potrzebne są jednak dalsze badania, aby w pełni potwierdzić długofalowe korzyści tych leków u pacjentów z epilepsją.
Oryginalny abstract (angielski)
PURPOSE: People with epilepsy (PWE) carry a disproportionate burden of type 2 diabetes mellitus, obesity, and cardiovascular disease, conditions for which glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly prescribed. As the use of these agents expands, neurologists are more frequently involved in the care of patients receiving GLP-1-based therapies. We reviewed current evidence regarding the neurologic safety, pharmacokinetic considerations, and potential clinical implications of GLP-1 RAs in PWE. METHODS: We conducted a scoping review following PRISMA-ScR principles of preclinical studies, observational cohorts, meta-analyses, and pharmacokinetic reports evaluating GLP-1 RA use in relation to seizures, epilepsy outcomes, antiseizure medication interactions (ASMs), and safety. RESULTS: Preclinical studies consistently suggest antiseizure and neuroprotective effects mediated through modulation of neuroinflammation, oxidative stress, and neuronal survival pathways. In human populations, large observational cohorts and meta-analyses have associated GLP-1 RA use with lower risks of incident seizures, reduced seizure recurrence, and fewer severe outcomes, including status epilepticus and hospitalization, with relative risk reductions ranging from approximately 10% to 57% across studies. GLP-1 RAs delay gastric emptying and may alter the timing of ASMs absorption; however, overall drug exposure appears largely unchanged in most cases. Available clinical and pharmacovigilance data do not indicate increased risks of seizure worsening or major neuropsychiatric adverse events. CONCLUSION: Current evidence suggests that GLP-1 RAs are generally safe and clinically relevant in appropriately selected PWE, with potential benefits extending beyond metabolic control. Because available human data remain largely observational, prospective epilepsy-specific studies are needed to clarify their long-term neurologic impact.