GLP-1 Receptor Agonists in ENT Surgery: Expanding Clinical Applications

A real-world analysis demonstrates that GLP-1 receptor agonists (GLP-1RAs) are associated with reduced revision surgery and improved disease control in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) who have obesity. The signal includes meaningful reductions in short- and longer-term revision rates, identifying a therapeutic intersection between metabolic management and sinonasal surgical outcomes.

Metabolic interventions have not traditionally been part of routine preoperative sinonasal care; weight-management therapies were managed separately from ENT. Obesity-related inflammatory burden and comorbidity correlate with higher rates of persistent disease and revision procedures. The central clinical question is whether targeting metabolic drivers can alter postoperative recurrence and reduce subsequent interventions.

The retrospective cohort evaluated 1,391 matched pairs of adults with CRSwNP and obesity who underwent functional endoscopic sinus surgery, comparing outcomes between patients who initiated GLP-1RA therapy after surgery and matched controls; the primary endpoints were revision surgery rates and longitudinal measures of disease control. A large federated EHR platform enabled follow-up to five years, reporting a 36% reduction in revision surgery at one year, a 40% reduction at five years, and an approximately 28% decrease in first-time biologic prescriptions among exposed patients. Translational studies link GLP-1RA exposure to reduced nasal-type inflammation and lower production of interleukin-33 in nasal epithelial cells; these anti-inflammatory effects, alongside weight loss, provide biological plausibility for the observed improvements in postoperative outcomes.