Comparison of Pediatric and Adult Glucagon-Like Peptide-1 Receptor Agonist Exposures Reported To United States Poison Centers, 2017-2024.
This retrospective observational study analyzed data from the National Poison Data System (NPDS) to characterize and compare glucagon-like peptide-1 receptor agonist (GLP-1 RA) exposures reported to U.S. poison centers between 2017 and 2024, focusing on differences between children (ages 6–17) and adults. Across 13,924 single-substance GLP-1 RA exposures, the authors found a dramatic overall increase of 1,830.8% in exposure rates over the study period, with an even steeper 4,805.0% rise among children 6–17 years old, most of which occurred after 2021. The majority of exposures (91.7%) resulted in no or mild effects; however, moderate effects were seen in 8.0% of cases and major effects in 42 exposures, with two deaths recorded. Children aged 6–17 were significantly more likely to be hospitalized than adults (RR: 2.66), and adolescents aged 12–17 were more likely to experience a serious medical outcome (RR: 1.68). Vomiting was the most common clinical effect in children (88.2%) versus adults (61.3%). Notably, exposures among children were far more likely to be classified as intentional misuse compared to adults (RR: 8.12). Limitations include reliance on voluntarily reported poison center data, potential underreporting, and inability to establish causation.
Why this grade: The study uses real-world national surveillance data from a large registry rather than a controlled or randomized design, limiting causal inference; findings are also subject to voluntary reporting bias and lack clinical detail.
Introduction As glucagon-like peptide-1 receptor agonist (GLP-1) use has increased among children, a better understanding of the related adverse effects in this population is needed. Methods National Poison Data System data from 2017 to 2024 were analyzed to compare characteristics and trends of exposures involving GLP-1s reported to United States (US) poison centers (PCs) among children 6-17 years old with those of adults. Results There were 13,924 single-substance GLP-1 exposures reported to US PCs from 2017 to 2024. The rate of exposures per one million US population increased by 1,830.8% from 0.97 in 2017 to 18.79 in 2024, including a 4,805.0% increase among children 6-17 years old from 0.04 in 2017 to 1.97 in 2024, with the majority of the increase occurring after 2021. Most exposures (91.7%) were associated with no or mild effects, while moderate effects were observed in 8.0% and major effects occurred in 42 exposures; there were two deaths. Children 6-17 years old were more likely (RR: 2.66, 95% CI: 1.73-4.11) to be admitted than adults, and children 12-17 years old were more likely (RR: 1.68, 95% CI: 1.08-2.63) to experience a more serious medical outcome than adults. Children 6-17 years old with at least one clinical effect experienced vomiting (88.2%) more commonly than adults (61.3%) (RR: 1.44, 95% CI: 1.34-1.55). Additionally, exposures among children 6-17 years old were more likely to be attributable to intentional misuse (RR: 8.12, 95% CI: 6.47-10.17) than among adults. Conclusions This study provides national-level, real-world findings that may help inform clinical practice.
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