Adding Zepbound (Tirzepatide) to Remicade for Weight Management in UC
It is safe to add Zepbound (tirzepatide) to infliximab therapy in patients with ulcerative colitis for weight management, as there are no known drug-drug interactions or mechanistic concerns between GLP-1/GIP receptor agonists and TNF antagonists.
Rationale for Safety
No Pharmacologic Contraindications
- Tirzepatide is a GLP-1/GIP receptor agonist that works through incretin pathways to regulate glucose metabolism and appetite, which operates independently of TNF-alpha blockade mechanisms 1
- The AGA guidelines for UC management do not list GLP-1 agonists or metabolic agents as contraindicated with infliximab or other TNF antagonists 1
- Infliximab's primary mechanism involves binding TNF-alpha to reduce intestinal inflammation, with no overlap in metabolic or incretin signaling pathways 2
Immunosuppression Considerations
- While infliximab increases infection risk through immunosuppression, tirzepatide does not have immunosuppressive properties 1, 2
- The AGA notes that vedolizumab and anti-IL therapies may have lower infection rates than TNF antagonists, but this relates to the biologic choice itself, not to concurrent metabolic medications 1
- No evidence suggests GLP-1/GIP agonists alter the safety profile of TNF antagonist therapy 1
Clinical Monitoring Recommendations
Disease Activity Assessment
- Ensure UC is in stable remission on infliximab before initiating weight management therapy, as active inflammation could complicate assessment of GI side effects 1, 2
- Monitor for any changes in UC symptoms, as tirzepatide's GI effects (nausea, diarrhea) could potentially be confused with disease flare 1
Practical Considerations
- Start tirzepatide at the lowest dose and titrate slowly to minimize GI side effects that could mimic UC symptoms 1
- Maintain therapeutic infliximab levels through standard monitoring, as weight changes from tirzepatide should not significantly affect dosing (infliximab is dosed by body weight at 5-10 mg/kg) 2
- Continue standard UC monitoring including clinical symptoms, inflammatory markers, and endoscopic assessment as indicated 1
Important Caveats
No Direct Evidence
- The provided guidelines focus exclusively on UC pharmacologic management and do not address concurrent metabolic therapies 1
- No studies specifically evaluate tirzepatide safety in IBD patients on biologics, though this reflects lack of investigation rather than safety concerns 1