Objective:

To assess whether initiation of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) was associated with changes in exercise activity and patient-reported outcomes (PROs) in people with multiple sclerosis (MS).

Background:

GLP-1 RAs, used for type 2 diabetes and obesity, have plausible central nervous system effects on neuroinflammation, energy, balance, fatigue, and mood, which may influence MS symptoms and improve physical activity.

Design/Methods:

We conducted a retrospective observational cohort study of MS patients treated with GLP-1 RA’s. Pharmacy and medication administration records identified GLP-1 RA initiation dates. We extracted self-reported physical activity (minutes/week of moderate-to-vigorous physical activity) and SymptoMScreen PROs, (13 domains, 0–6 scale) collected routinely during visits at the last MS center visit prior to initiation and compared to visits ≥6 months after. Patients without data for either visit were excluded; those treated with multiple GLP-1 RAs were included only for their first exposure. Paired within-person comparisons assessed pre- and post-exposure changes.

Results:

Seventy patients were included (mean age 51.3 years, 87% female, median EDSS 2.5 [IQR 1.0–4.5]). Follow-up visits were 7.2 months (218 days) after initiation of GLP-1 RA on average. Physical activity increased from 52.3 to 115.7 minutes/week after GLP-1RA initiation (mean change +65.8, 95% CI +48.5 to +83.0, p<0.001). Significant improvements were observed in anxiety (–0.65), bowel dysfunction (–0.52), bladder dysfunction (–0.64), and sensory symptoms (–0.54), all p<0.001. Smaller but significant improvements noted in body pain (–0.48, p=0.004), vision (–0.31, p=0.04), spasticity (–0.28, p=0.03), and dizziness (–0.39, p=0.02). No significant changes were seen in walking, hand function, fatigue, cognition, or depression.

Conclusions:

GLP-1 RA initiation in MS was associated with greater physical activity and improvements in several PRO domains, further supporting association of metabolic health with MS outcomes and need for prospective studies to validate these findings.