Safety and Efficacy of Glucagon-Like Peptide-1 Receptor Agonists Use in Elderly People With Obesity-A Meta-Analysis.

Abstract

This meta-analysis evaluates the safety and efficacy of glucagon-like peptide-1 receptor agonists (GLP-1 RA) for the treatment of older adults with obesity compared to younger individuals. A systematic review was conducted following PRISMA guidelines (PROSPERO CRD420251074381). PubMed, Embase, and Scopus were searched until May 17, 2025, for randomized controlled trials and observational studies assessing GLP-1 RA in adults ≥ 65 years with obesity with or without type 2 diabetes. Random effects meta-analyses calculated the log odds ratios (LOR) for dichotomous outcomes and the mean differences (MD) for continuous outcomes, with equivalence testing via two one-sided tests (TOST) and meta-regression for baseline adjustments. Five studies involving 1229 participants were included. No significant difference in serious adverse events was found between older and younger adults (pooled LOR: 0.06, p = 0.9). Older adults had a trend toward lower frequency of nausea (LOR: -0.44, p = 0.06) but higher incidence of constipation (LOR: 0.72, p = 0.02) and hypoglycemia (LOR: 0.97, p < 0.001). Efficacy in metabolic and weight control was comparable. Additionally, one study suggested that liraglutide could reduce fat mass without worsening sarcopenia. GLP-1 RA therapy seems to be safe and effective in older adults with obesity, achieving similar effects on weight loss and glycemic control as in younger individuals.