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Acute, but not chronic, exendin-4 treatment increases Fgf7 mRNA expression in the small intestine (Koehler et al., 2015)

It's a direct and reliable mechanism that works regardless of individual microbiome composition

Alang N, Kelly CR (2015) Weight gain after fecal microbiota transplantation

Any effect on GLP-1 appears to be indirect and secondary, with the evidence remaining limited and inconsistent

While the topical drug does not come with a boxed warning, its label does carry warnings for uveitis and other common adverse effects of treatment, including site discomfort and conjunctival hyperemia

Toxicology 104:9197