Clinics and Practice
Semaglutide Exposure and Risk of Oral Mucositis, Systemic Complications, and Mortality Among Patients with a History of Hematopoietic Stem-Cell Transplantation: A Propensity-Matched Real-World Cohort Study
By Zak Ahmed, Kiera Kavcic, Joel Epstein and 6 others.
Abstract
Background
Oral mucositis is a major toxicity of hematopoietic stem-cell transplantation (HSCT). In preclinical models, glucagon-like peptide-1 (GLP-1) signaling promotes intestinal epithelial repair after chemotherapy-induced injury, but its relationship to oral mucositis after transplantation is undefined. We hypothesized that semaglutide would be associated with a lower risk of stomatitis and oral mucositis, without increased xerostomia, and with fewer systemic complications.
Methods
Using the TriNetX COVID-19 Research Network (88 healthcare organizations; query executed 13 August 2026), adults aged 18–90 with stem-cell transplant status (ICD-10-CM Z94.84) were classified as semaglutide-exposed or unexposed. The index date was the first date on which all cohort-defining criteria were met; because Z94.84 is a status code, the index date does not correspond to the date of transplantation. Long-term outcomes were assessed from day 30 after the index date until the end of available records; oral mucositis was assessed as a 3-month outcome (days 1–90 after the index date) in a separate propensity-matched analysis that additionally balanced underlying hematologic diagnoses. The primary endpoint was stomatitis and related lesions (K12); oral mucositis (K12.3, a subcategory of K12) was the key secondary endpoint. Dry mouth, taste/smell disturbances, candidal stomatitis, food and fluid intake codes, systemic inflammation, influenza/pneumonia, graft-versus-host disease, and mortality were exploratory endpoints. One-to-one propensity-score matching was used to balance age, sex, race/ethnicity, type 2 diabetes, external causes of morbidity, body-mass index, and Eastern Cooperative Oncology Group (ECOG) performance status.