Glucagon-Like Peptide-1 Receptor Agonists in Multiple Sclerosis: A Topical Narrative Review

The glucagon-like peptide-1 (GLP-1) receptor agonists (RAs) are a relatively new class of drugs that were initially approved by the US Food and Drug Administration to improve glycemic control in patients with type 2 diabetes mellitus and, subsequently, weight reduction in patients with obesity. Multiple sclerosis (MS) is commonly associated with comorbidities for which GLP-1RAs are indicated. An increasing prevalence of comorbid chronic diseases has increased the number of people living with MS (pwMS) who are prescribed a GLP-1RA, for indications of obesity, diabetes, obstructive sleep apnea, metabolic-associated steatohepatitis, and/or chronic kidney disease. This review addresses the following key considerations: (1) the use of GLP-1RAs for weight loss in pwMS and obesity, including considerations related to drug tolerability and safety; (2) the efficacy of the GLP-1RAs for their approved non-MS indications in pwMS; and (3) the potentially pleiotropic effects of the GLP-1RAs on the MS disease course beyond their approved indications.