From the FDA Drug Label
The following additional adverse reactions have been reported during post-approval use of liraglutide injection. Because these events are reported voluntarily from a population of uncertain size, it is generally not possible to reliably estimate their frequency or establish a causal relationship to drug exposure Hepatobiliary: Elevations of liver enzymes, hyperbilirubinemia, cholestasis, cholecystitis, cholelithiasis requiring cholecystectomy, hepatitis
Hepatic Injury Risk with GLP-1 Receptor Agonists:
- There is a reported risk of hepatic injury with GLP-1 receptor agonists, including elevations of liver enzymes, hyperbilirubinemia, cholestasis, and hepatitis.
- The clinical significance and causal relationship of these findings are unknown due to the voluntary reporting of events from a population of uncertain size 1.
From the Research
There is a low risk of hepatic injury with GLP-1 receptor agonists, and they are generally considered safe for liver function. Most GLP-1 receptor agonists like semaglutide, liraglutide, dulaglutide, and exenatide have not shown significant hepatotoxicity in clinical trials or post-marketing surveillance, as seen in a study published in the Journal of pharmacy practice 2. In fact, these medications may actually benefit patients with non-alcoholic fatty liver disease (NAFLD) by reducing liver fat content and improving liver enzyme levels through their effects on weight loss and glycemic control, as suggested by a study in Gastroenterology 3. However, rare cases of drug-induced liver injury have been reported, particularly with exenatide. Patients with pre-existing liver disease should be monitored with liver function tests before and during treatment, as recommended by a study in Gut 4. The mechanism behind the potential liver benefits involves reduced inflammation, improved insulin sensitivity, and decreased fat deposition in the liver. Some key points to consider when prescribing GLP-1 receptor agonists include:
- Monitoring liver function tests in patients with pre-existing liver disease
- Being aware of the potential for rare cases of drug-induced liver injury
- Considering the benefits of GLP-1 receptor agonists in patients with NAFLD, as seen in a study in Diabetes care 5
- Weighing the risks and benefits of GLP-1 receptor agonists in patients with a history of liver disease, as discussed in a study in Hepatology (Baltimore, Md.) 6 If a patient develops symptoms of liver injury such as jaundice, right upper quadrant pain, or significantly elevated liver enzymes while taking a GLP-1 receptor agonist, the medication should be discontinued and appropriate evaluation performed.