Abstract / Summary
Asthma outcomes are often suboptimal in patients with coexisting obesity and/or metabolic comorbidities. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), widely used for the management of type 2 diabetes mellitus (T2DM) and obesity, have demonstrated potential anti-inflammatory and metabolic effects that may influence asthma-related outcomes. This systematic review aimed to evaluate the effects of GLP-1 RAs on asthma outcomes in this population. This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement and a prospectively registered PROSPERO protocol (CRD420261361548). A comprehensive literature search was performed in PubMed/MEDLINE, Embase, CINAHL, Scopus, and Web of Science from database inception to 1 April 2026. Eligible studies included observational and interventional studies evaluating GLP-1 RA therapy in children or adults with asthma and obesity and/or metabolic comorbidities. Outcomes of interest included asthma control, exacerbations, lung function, and metabolic parameters. The feasibility of quantitative synthesis was assessed according to outcome and comparator group; because most clinically meaningful strata contained too few sufficiently comparable estimates for robust pooling, a structured narrative synthesis was performed. Eight observational cohort studies were included. GLP-1 RA therapy was associated with reductions in asthma exacerbation risk in several observational comparisons, although findings were not consistent across comparator groups. Evidence for improvements in asthma control was limited and based primarily on indirect or proxy measures, such as short-acting β₂-agonist use and healthcare encounters ( n = 3), with no reports using validated control instruments (e.g., Asthma Control Test [ACT] or Asthma Control Questionnaire [ACQ]). Lung function outcomes were rarely reported ( n = 1), with no meaningful improvements observed in the limited available data. Data on weight and metabolic outcomes in the context of asthma were sparse, with only one report providing quantitative weight change, precluding meaningful synthesis. GLP-1 RA use was associated with a lower risk of asthma exacerbations in several, but not all, observational comparisons. Evidence regarding asthma control was limited and based primarily on proxy measures, while data on lung function and metabolic outcomes were sparse. Given the observational nature and heterogeneity of the available evidence, these findings do not establish a causal treatment effect. Not applicable.