Effect of GLP-1 receptor agonists on tacrolimus levels in renal transplant recipients: a systematic review and meta-analysis.

Abstract

Introduction: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly used to treat metabolic disorders in kidney transplant (KT) recipients. However, their effect on tacrolimus absorption and blood concentrations remains a concern due to the narrow therapeutic index of this immunosuppressant and the potential risk of rejection or toxicity.

Materials and methods: A systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Studies involving adult KT recipients treated with GLP-1 RAs and tacrolimus were included. Priority was given to clinically stable participants without active graft rejection and with stable tacrolimus dosages (no recent modifications). Changes in tacrolimus levels were modeled using a random-effects model and expressed as the mean difference (MD) with a 95% confidence interval (95% CI).

Results: Six studies were included. Treatment with GLP-1 RAs did not result in statistically significant changes in tacrolimus levels. The pooled mean difference was −0.08 ng/mL (95% CI: −0.35 to 0.19; p = 0.56). No heterogeneity was identified among the included studies (I² = 0%; p = 0.46), indicating consistent results regarding the stability of immunosuppressant concentrations.

Conclusions: The use of GLP-1 RAs was not associated with clinically relevant changes in tacrolimus levels in KT recipients. These results suggest that both treatments can be administered concomitantly; however, monitoring of tacrolimus concentrations should be maintained, particularly when initiating or adjusting GLP-1 RA therapy.