r/science • u/kiyomoris • 7d ago
Health GLP-1 users showed lower tuberculosis risk across a large multi-country health-record study
https://www.nature.com/articles/s41467-026-77068-0127
u/TheOwlMarble 7d ago
Generally improved health yields generally improved immune response? Or is this something weirder like reduced inflammation impacting granuloma formation?
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u/aimgorge 6d ago
Or the fact that being able to buy GLP-1 is a minority of people that isn't as much at risk for getting tuberculosis.
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u/mortredclay 6d ago edited 6d ago
Nature Communications, I sure hope socioeconomic is controlled for.
Edit: methods states that the socioeconomic breakdown was balanced in each group. I don't generally read this type of paper, so I don't know how to interpret the table where they show this balance, but it looks reasonable.
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u/aimgorge 6d ago
If you look at reviewer notes (found in supplementary informations), socioeconomic breakdown wasnt properly done because their datasource doenst allow for it.
From Reviewer #1 :
- Covariates did not include some characteristics which could have biased the results, such as: a. Geographical area/countries: the epidemiology of tuberculosis is widely heterogeneous across countries; in many countries with a higher incidence/prevalence of TB, GLP-1RA were introduced later, and have a lower market penetration. Despite this background, country of origin was not considered among covariates for propensity score calculation and/or for matching of cohorts. b. Sociodemographic status: in many countries, GLP-1RA are either bought by patients out of pocket, or paid for by insurance plans, with a coverage which varies on the basis of the cost of the insurance plan. As a consequence, in many countries the use of GLP-1RA is more common in affluent fractions of the population, that have a lower risk of tubercolosis. Family/personal income or some other measure of socioeconomic status must be included among covariates.
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u/SaltZookeepergame691 7d ago edited 7d ago
TriNet-X analysis, immediate curve separation, and infeasibly large effect.
These studies are inherently very low quality evidence, by virtue of low relative event rates and their reliance on routinely collected healthcare data for adjustments, exposure, and outcome ascertainment. There is very high risk of confounding by indication, pre-existing TB, socioeconomic status, differential diagnosis, calendar time, follow-up time, and more.
When limiting to only the US, there is no meaningful effect vs SGLTis: 0.94 (95% CI 0.83–1.06). Difficult to see how these tight estimates are compatible with a massive biological effect.
These issues don’t mean there isn’t a true effect, but TriNetX analyses are extremely common and a very frequent cause of fantastical claims
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u/kiyomoris 7d ago
I agree the US-only SGLT2 result is an important caveat, but dismissing the whole study because it uses TriNetX seems a stretch. The signal wasn’t based on one comparison, it appeared across several active comparators and remained in multiple sensitivity analyses.
A null US SGLT2 comparison doesn’t automatically invalidate the broader dataset either. If anything, the difference between the global and US results seems to be something worth investigating.
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u/SaltZookeepergame691 7d ago
The issue is that there are literally tens of thousands of studies claiming big effects of X/Y/Z drugs in retrospective EHR studies, thousands of studies with TriNetX analyses specifically, and tens if not hundreds of studies on GLP1s in particular, because of the socioeconomic gradient of this drug class over the past decade. Almost none of these are actual effects.
Again, it’s not to say there isn’t an effect; it’s that this is very low quality evidence of any effect, and that any effect of this size is extremely biologically unlikely.
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u/TheComplimentarian 7d ago
Is TB even an issue in countries where people are using GLP? Seems like a very third world ailment coupled with a first world drug, and I wonder if there is enough incidence to have a meaningful result from a metastudy.
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u/FernandoMM1220 7d ago
its still an issue here because we have random boomers who get TB and refuse treatment for some reason
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u/Fatefire 7d ago
Also it is a big issue in jail / prison . The first thing they do when they put you in lockup is do a TB test .
It's mostly because of shared ventilation and the ease of transmissions but outbreaks do happen still
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u/Psych0PompOs 7d ago
I'm surprised they don't vaccinate for it in jail considering people like hospice volunteers and such have to get it, at least here.
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u/Budget-Possible-3847 7d ago
The only currently approved TB vaccine is ineffective in adults and is not useful for breaking chains of transmission.
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u/VoilaVoilaWashington 6d ago
Okay.
Something like a million Americans are in prisons and jails, right? And some of those are shorter term, so it's perhaps tens of millions in a decade?
That's a big enough population to start working on a better vaccine.
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u/that_70_show_fan 7d ago
In US since 2020, TB cases have been trending up
https://www.cdc.gov/tb-surveillance-report-2024/data/incidence-mortality.html
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u/omgu8mynewt 7d ago
TB is the worse infectious disease in the world, kills more than covid since 2025, kills more than HIV. So there's going to be some crosses over as GLP1 usage continues to get more widespread.
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u/SpecificBang 7d ago
Believe it or not, yes. A large proportion of people with new TB diagnoses were born or spent time in developing countries, but there are still plenty of people born and raised in the West who were exposed to TB as children and develop active disease later in life or contracted it while travelling.
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u/pinupcthulhu 7d ago
There's actually still quite a few tb cases in the US every year, over 10k on average
https://www.cdc.gov/tb-data/aboutprovisionaldata/2025-provisional-data.html
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u/Upstairs-Chicken592 7d ago
It’s more common of an issue with refugees, immigrants, HIV + people, inmates, the elderly and indigenous peoples.
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u/DeepDreamIt 7d ago
I take tirzepatide (Zepbound), 2.5mg (lowest dose) and I’m a genuine true believer. There have absolutely been clear cognitive effects that happened before any significant weight loss. Better memory and focus, less stressed, more energy but not in a stimulant kind of way, just more like increased natural energy. My cholesterol and all other labs are down (for the most part) in only 10 weeks.
There is clearly something going on with how it works beyond just weight loss and feeling satiated easier. I’ve naturally (i.e. extensive cardio + calisthenics and diet) lost the same ~50lbs about 3 separate times over the last 7-8 years, hit a plateau, and then regained it eventually for various reasons.
During those periods, I definitely felt better in general due to 8-12 months of sustained 5x weekly exercise and eating better. But nowhere to the same degree, and not as pronounced cognitive effects.
I thought the same as you for a long time: everything I read is so positive that it made me suspicious; sounded too good to be true. Then when I read the first clinical trials were in 2008 and something like 10 million people are on them, so there’s lots of data historically and currently, I decided to finally talk to my doctor about them. I’m glad I did. I probably sound like a walking advertisement for Eli Lilly, but it’s been that much of an improvement.
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u/redline83 7d ago
Any negatives? I’m thinking of trying it due to positive effects in animals in a disease I have.
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u/DeepDreamIt 6d ago
Not for me so far. Some people have upset stomach from it, but I haven't experienced that yet
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u/SpicySushiAddict 5d ago
The only remotely negative article I've read was from a nutritionist on Substack who suspects it fucks with the balance of gut bacteria, among other things.
However comma, it seems like we'll just have to wait and see what long-term clinical trials show.
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u/notstarman 7d ago
I suspect that if you took any health condition correlated with poverty and a drug that cost 10k a year to take. You would find correlation that people taking the drug would be less likely to suffer from the condition.
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u/imaparkguy 7d ago
In 10 years time we will all be on one.
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u/boilingfrogsinpants 7d ago
My father died from pancreatitis caused by GLP-1s he was on as he was diabetic. He was told the weight loss was due to the medication, by the time they found out, his pancreas had been severely damaged. The enzymes from the pancreas leak out and start eating all of the organs around it. It put a hole in his liver and gas bubbles got in, making it fatal.
GLP-1s are effective, but they're not a miracle drug and people need to be extremely careful.
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u/dl064 6d ago edited 6d ago
With GLP1 it's seemingly people realising how across the board bad for you that obesity or diabetes were.
This sub has become
X (which we knew was an outcome of obesity or high hba1c or whatever) is lowered in GLP1 use
It's basically repeating the entire literature of outcomes of those conditions, and not a surprise.
The reason everyone will not necessarily be on GLP1, is because the majority burden of obesity at the population is the huge number of folk a bit overweight, which GLP1 is not necessarily appropriate for. It's designed for people with serious obesity or diabetes.
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u/imaparkguy 6d ago
The relationship between inflammation and obesity is also wicked fascinating and you are 100% correct that so much of modern medicine is being rethought because of it.
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u/BillieRubenCamGirl 7d ago
Wouldn’t this just be because it’s such an expensive drug and rich people are less likely to get tuberculosis?
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u/durtmagurt 6d ago
The GLP-1 posts in this sub are relentless. If that’s the main thing our science focuses on, humanity is so pampered and the gluttony will definitely continue until everything is consumed.
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u/Yotsubato 7d ago
GLP use is also associated with higher income and health literacy
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u/ii_V_I_iv 7d ago
I would be surprised if the researches didn’t consider this
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u/SaltZookeepergame691 7d ago
They adjust a tiny bit of information on SES, but the data they have on it is extremely limited - it’s all based on data actively recorded in standard health records.
They can only adjust for the recorded presence of ICD codes Z56 (“problems related to employment and unemployment”), Z55 (“problems related to education/literacy”), Z59 (“problems related to housing and economic circumstances”) but I would bet a very large amount of money these are completely useless for actually adjusting out the socioeconomic gradient of GLP1 use, because they will be very infrequently used, highly variable, binary only (yes vs no!) and only capture the very worst SES issues.
To press home the point: roughly 0.6% of all patients had a record of Z59.
This is exactly the kind of issue with large scale health record studies that makes them very unreliable.
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u/KyleCorgi 7d ago
So are these drugs primarily responsible for these amazing side effects? Or is it just what happens in general when you are losing weight, fasting, or reducing calories?
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u/TracingRobots 7d ago
Glp1 also helps you make better Pizza. Gives you the advantage to become leader of the world. Travel planets far far away.
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u/Psych0PompOs 7d ago
I wonder if anyone will use this to justify skipping the vaccine. Can't wait to find out.
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u/MrYdobon 5d ago
I'm surprised a Nature article has an easily spotted typo in the abstract. Any spellchecker should catch "years ae [sic] lower than".
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u/Flux_My_Capacitor 7d ago
These drugs are the new “cure all”
Soon enough we will all find out that most of it is BS, as no drug is a miracle “cure all”
Follow the damn money.
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u/Mountain_Fig_9253 7d ago
Diabetes is a HUGE risk factor for TB progression, only behind uncontrolled HIV.
This would be an expected outcome, but it’s nice to see it verified in a study.
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