{
  "abstract": "To compare the 1-year risk of biliary/pancreatic adverse events among patients with obesity and type 2 diabetes treated with glucagon-like peptide-1 receptor agonists (GLP-1RAs) versus dipeptidyl peptidase-4 inhibitors (DPP-4i), and to directly compare tirzepatide with semaglutide. Methods: We conducted a retrospective propensity score-matched cohort study using the TriNetX Global Collaborative Network. Adults with obesity and type 2 diabetes without prior biliary or pancreatic disease were included. Two prespecified comparisons were performed: GLP-1RA (semaglutide or tirzepatide) versus DPP-4i, and tirzepatide versus semaglutide. The primary outcome was incident cholelithiasis at 1 year. Secondary outcomes included cholecystitis, cholangitis, acute pancreatitis, and cholecystectomy. Hazard ratios (HRs) were estimated using Cox proportional hazards models. Results: After matching, 281,283 patients were included in each GLP-1RA and DPP-4i cohort, and 242,876 patients in each tirzepatide and semaglutide cohort. Compared with DPP-4i, GLP-1RA therapy was associated with lower risks of cholelithiasis (1.02% vs. 1.16%; HR 0.92, 95%CI 0.87–0.96), cholecystitis (HR 0.88, 95%CI 0.79–0.98), cholangitis (HR 0.46, 95%CI 0.36–0.58), acute pancreatitis (HR 0.68, 95%CI 0.61–0.76), and cholecystectomy (HR 0.51, 95%CI 0.38–0.69). In the head-to-head comparison, semaglutide was associated with higher risks of cholelithiasis (HR 1.11, 95%CI 1.05–1.18) and cholecystitis (HR 1.22, 95%CI 1.10–1.37) compared with tirzepatide, while risks of pancreatitis, cholangitis, and cholecystectomy did not differ significantly. Conclusions: In this large real-world study, GLP-1RA therapy was associated with lower risks of biliary and pancreatic events compared with DPP-4i. Tirzepatide demonstrated a modestly more favorable biliary safety profile than semaglutide, supporting the overall hepatobiliary safety of contemporary GLP-1-based therapies.",
  "abstract_shown": true,
  "affiliations": [
    "Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA",
    "Department of Internal Medicine, Saint Louis University, St. Louis, MO 63104, USA",
    "Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Jacksonville, FL 32224, USA"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 3,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Wissam Ghusn",
      "orcid": "0000-0002-9389-6795"
    },
    {
      "affs": [
        1
      ],
      "name": "Sasha-Jane Abi-Aad"
    },
    {
      "affs": [
        0,
        2
      ],
      "name": "Maria Daniela Hurtado",
      "orcid": "0000-0002-2322-7334"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/0xvm0bywzh2gn.bib",
  "cited_by": 0,
  "doi": "10.3390/jcm15208027",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13706158/?tool=EBI",
  "id": "0xvm0bywzh2gn",
  "issns": [
    "2077-0383"
  ],
  "landing_url": "https://www.mdpi.com/2077-0383/15/20/8027",
  "language": "eng",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2712|Diabetes Treatment and Management"
    ]
  ],
  "openalex": "W7222715361",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13706158/pdf/?tool=EBI",
  "pmcid": "PMC13706158",
  "pmid": null,
  "published": "2026-10-01",
  "publisher": "MDPI AG",
  "ris": "https://research.draconitic.com/paper/0xvm0bywzh2gn.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:00Z",
      "native_id": "10.3390/jcm15208027",
      "source": "crossref",
      "url": "https://www.mdpi.com/2077-0383/15/20/8027"
    },
    {
      "first_seen": "2026-10-30T12:21:25Z",
      "native_id": "PMC:PMC13706158",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13706158"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2712|Diabetes Treatment and Management",
      "subfield": "endocrinology-metabolism"
    }
  ],
  "title": "Biliary and Pancreatic Safety of Incretin-Based Therapies in Obesity and Type 2 Diabetes: A Propensity-Matched Real-World Comparison of Tirzepatide, Semaglutide, and DPP-4 Inhibitors",
  "title_text": "Biliary and Pancreatic Safety of Incretin-Based Therapies in Obesity and Type 2 Diabetes: A Propensity-Matched Real-World Comparison of Tirzepatide, Semaglutide, and DPP-4 Inhibitors",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:21:25Z",
  "url": "https://research.draconitic.com/paper/0xvm0bywzh2gn",
  "venue": "Journal of Clinical Medicine",
  "versions": []
}