Comment on: Clinical outcomes associated with prior GLP-1 exposure in burned patients

Correspondence to: Xiaodong Li (email: 13933168616@139.com)

Bethune International Peace Hospital

Shijiazhuang

050082

Hebei

China

BJS, https://doi.org/10.1093/bjs/znag048, published 20 April 2026

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We read with great interest the BJS article by Boukind et al.1. The study provides important real-world evidence on GLP-1 receptor agonist use and outcomes after burn injury. However, several methodological points may deserve further consideration.

First, calendar time may be important. GLP-1 use among burn patients increased from 1.3% in 2018 to 10.1% in 2025, but index year was not listed as a matching variable. As target trial emulation principles emphasize clear alignment of time zero, exposure, and follow-up2, matching or adjusting for calendar year would help separate GLP-1 exposure from changes in burn care, ICU use, antibiotic practice, coding, and prescribing patterns.

Second, the hypertrophic scarring result should be interpreted carefully. This signal appeared only in the 3-year exposure window. In the same window, mortality was lower among GLP-1 users. Because death prevents later scar recording, a higher rate of documented hypertrophic scarring may partly reflect longer survival and more chance for follow-up. A competing-risk analysis3, treating death as a competing event, would help clarify this result.

Third, the supplementary analysis tested many outcomes across three exposure windows. A clear main-outcome plan or false-discovery-rate correction4 would help distinguish stronger findings from exploratory results, especially for wound-related outcomes.

Finally, an active-comparator new-user design, for example comparing GLP-1 users with users of another glucose-lowering drug, may reduce bias from prescribing patterns and healthcare contact5. These analyses would help define which associations are most reliable and which should be tested prospectively.