Efficacy of the Glucagon-Like Peptide-1 Receptor Agonists Liraglutide and Semaglutide for the Treatment of Weight Regain After Bariatric surgery: a Retrospective Observational Study

Abstract

Purpose Weight regain after bariatric surgery occurs in up to a third of patients and reduces treatment-associated health benefits. The efficacy of glucagon-like peptide-1 receptor agonists (GLP1-RA) for treatment of type 2 diabetes mellitus and obesity is well established, but their role in the treatment of weight regain after bariatric surgery remains to be defined. Materials and Methods This was a single centre retrospective observational study conducted at a Swiss bariatric reference centre. Patients with 6 months of treatment with GLP1-RA, up until November 2021, due to weight regain after bariatric surgery were identified. Data on body weight and relevant clinical parameters were collected before and after 6 months of treatment with GLP1-RA. Data are presented as median (interquartile range). Results Fifty patients (82% female) were included. Before GLP1-RA treatment (liraglutide, n =29; semaglutide, n =21), weight and BMI were 90.5 kg (83.4, 107.9) and 34.0 kg/m 2 (31.7, 38.7), respectively, with a post-bariatric weight regain of 15.1% (10.6, 22.8) of total body weight and 4.6 kg/m 2 (3.3, 6.2). After 6 months of GLP1-RA treatment, a reduction in weight and BMI of 8.8% (5.2, 11.4) of total body weight and 2.9 kg/m 2 (1.8, 4.0) was observed ( P value <0.0001), corresponding to 67.4% (40.4, 92.2) of the weight regain. No serious adverse events were reported. Conclusion For patients experiencing weight regain after bariatric surgery, two-thirds of the weight regain can be safely lost with GLP1-RA, providing clinicians with a therapeutic option for this clinical challenge, and highlights the need for a large-scale randomized clinical trial. Graphical Abstract Supplementary Information The online version contains supplementary material available at 10.1007/s11695-023-06484-8.

Semaglutide 2.4 mg/wk for weight loss in patients with severe obesity and with or without a history of bariatric surgery

“…Furthermore, statistical analysis showed no significant difference in weight-loss outcomes between patients with and without a history of BS. These findings align with prior studies that have examined the efficacy of GLP-1-RAs in managing obesity [11][12][13][14][15][16]; however, our study is distinctive as the first, to our knowledge, to employ the higher dose of semaglutide, which is currently recommended for individuals living with obesity. This outcome implies that post-BS alterations in hormonal secretions or changes in gut microbiota do not significantly influence the response to GLP-1-RAs [21].…”

“…Our study uniquely provides real-world evidence of the effectiveness of semaglutide in patients with a history of BS who have not achieved sufficient weight loss or who have experienced weight regain. Notably, our research is distinctive in its approach of comparing the efficacy of semaglutide patients with and without a history of BS, which is an element not specifically addressed in previous studies [11][12][13][14][15][16]. Moreover, this is the first study of its kind, to our knowledge, to exclusively focus on individuals with severe obesity, defined as having a BMI greater than 40 kg/m 2 and associated comorbidities (hypertension, dyslipidemia, history of CVD, or OSA with equipment).…”

“…has not yet been fully evaluated. Previous studies have investigated the use of liraglutide [11][12][13] or semaglutide [14][15][16] at lower doses after BS, but few have specifically targeted this patient population. These studies show efficacy on weight loss with sometimes superior effects compared with a new BS [11].…”

“…However, the efficacy of semaglutide in patients with a body mass index (BMI) ≥ 40 kg/m 2 who have undergone BS and still have obesity‐related comorbidities has not yet been fully evaluated. Previous studies have investigated the use of liraglutide [11–13] or semaglutide [14–16] at lower doses after BS, but few have specifically targeted this patient population. These studies show efficacy on weight loss with sometimes superior effects compared with a new BS [11].…”

“…Patients who stopped treatment(15):Adverse events (10) Lack of efficacy(2) Lost to follow-up (3) Death (1) Patients who stopped treatment (3): Adverse events (2) Lost to follow-up (1) Patients with a history of bariatric surgery (BS+) N = 36 Patients without history of bariatric surgery (BS-) Study flowchart. T A B L E 1 Characteristics of the population at baseline…”