Use Of Liraglutide For Weight Loss In Patients With Prior Bariatric Surgery

Creange, Collin; Lin, Edward; Ren-Fielding, Christine; Lofton, Holly

doi:10.1016/j.soard.2016.08.281

Cited by 7 publications

(6 citation statements)

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“…There is a paucity of published data on the efficacy of GLP‐1‐RA therapies for managing post‐bariatric weight regain across a broad variety of surgeries. Our study supports the findings of several smaller retrospective analyses that found liraglutide 3.0 mg daily to be effective for weight loss after bariatric surgery (12‐15). By comparison, our cohort had greater numbers of individuals with a history of sleeve gastrectomy, which is now the most commonly performed bariatric procedure (12‐16).…”

Section: Discussionsupporting

confidence: 90%

“…Our study supports the findings of several smaller retrospective analyses that found liraglutide 3.0 mg daily to be effective for weight loss after bariatric surgery (12‐15). By comparison, our cohort had greater numbers of individuals with a history of sleeve gastrectomy, which is now the most commonly performed bariatric procedure (12‐16). A retrospective review by Rye et al reported the effectiveness of high‐dose liraglutide in 20 people who experienced weight regain, insufficient weight loss, or plateau after a variety of bariatric procedures, but they did not compare weight loss with non–GLP‐1‐RA‐based WLP therapies or lifestyle modification (17).…”

Section: Discussionsupporting

confidence: 90%

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Pharmacotherapies for Post‐Bariatric Weight Regain: Real‐World Comparative Outcomes

Gazda

Clark

Lingvay

et al. 2021

Obesity

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Objective This study aimed to compare outcomes of treatment strategies for weight regain after bariatric surgery. Methods This is a retrospective analysis of 207 individuals treated for post‐bariatric weight regain at an academic center from January 1, 2014, through November 25, 2019. Percentage body weight loss was compared after 3, 6, 9, and 12 months of treatment among an intensive lifestyle modification (ILM) group, a non–glucagon‐like‐1 receptor agonist (GLP‐1‐RA)‐based weight‐loss pharmacotherapy (WLP) group, and a GLP‐1‐RA‐based WLP group (the latter two groups in conjunction with ILM). Results The percentage body weight loss was significantly different between groups after 3 months (1.4% vs. 2.2% vs. 4.5% [P < 0.001] for ILM, non–GLP‐1‐RA‐based WLP, and GLP‐1‐RA‐based WLP groups, respectively), 6 months (0.8% vs. 2.9% vs. 6.7% [P < 0.001]), and 9 months (−1.6% vs. 5.6% vs. 6.9% [P = 0.007]). There was a significant difference in the percentage of individuals achieving ≥5% weight loss after 3, 6, and 9 months, with most occurring in the GLP‐1‐RA‐based WLP group. In a multiple regression analysis including bariatric surgery type, treatment group was the only significant predictor of percentage weight change. Conclusions GLP‐1‐RA‐based WLP therapies were found to be more effective for treating post‐bariatric weight regain than non–GLP‐1‐RA‐based WLP or ILM, regardless of surgery type.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 90%

Pharmacotherapies for Post‐Bariatric Weight Regain: Real‐World Comparative Outcomes

Gazda

Clark

Lingvay

et al. 2021

Obesity

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“…The heterogeneity of our cohort in terms of glycaemic and weight loss response to surgery reflects the pragmatic nature of this RCT and enhances its potential for translation to routine clinical practice. Our results are consistent with our findings in rodents in which the acute peripheral administration of Exendin-4 in rodent models of RYGB had similar effects in the reduction in food intake both in RYGB and sham-operated rats 11 , and with the few retrospective studies in which GLP-1 RAs were used in patients with persistent or recurrent T2DM, suboptimal weight loss or weight regain after metabolic surgery [12][13][14][15] . It is interesting that the impact of the tested doses of Liraglutide on glucose and weight reduction in our cohort was almost identical to that observed in patients with T2DM who have not had metabolic surgery previously 23 .…”

Section: Discussionsupporting

confidence: 91%

Adjunctive liraglutide treatment in patients with persistent or recurrent type 2 diabetes after metabolic surgery (GRAVITAS): a randomised, double-blind, placebo-controlled trial

Miras

Pérez-Pevida

Aldhwayan

et al. 2019

The Lancet Diabetes & Endocrinology

115

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Background: Obesity surgery is effective for obesity and type 2 diabetes (T2DM). However, many patients do not achieve sustained diabetes remission following surgery. Liraglutide, a GLP-1 analogue, improves glycaemia and reduces body weight. Our aim was to evaluate the safety and effectiveness of Liraglutide 1•8 mg in patients with persistent or recurrent T2DM after surgery. Methods: In this double-blind, placebo-controlled trial, adults with HbA1c >48 mmol/mol (>6•5%) at least one year after surgery were randomised 2:1 to once-daily subcutaneous Liraglutide 1•8 mg or Placebo, together with a reduced-calorie diet and increased physical activity. The primary outcome was the change in HbA1c from baseline to 26 weeks. EudraCT 2014-003923-23 and ISRCTN 13643081. Findings: Between February 2016 and November 2018, we assigned 80 patients to receive Liraglutide (n=53) or Placebo (n=27). Seventy-one (89%) participants completed the study up to week 26 (complete-cases population). A multivariable linear regression analysis taking baseline HbA1c and type of surgery into account as covariates showed that Liraglutide was associated with a difference in HbA1c change of-13•3 mmol/mol or-1•22%, 95% CI-19•7 to-7•0, p<0•001) vs Placebo at 26 weeks. Liraglutide was associated with a difference in the change of weight of-4•23 kg [95% CI-6•81 to-1•64, p<0•001) vs Placebo. No significant influence of type of surgery was noted. Interpretation: This is the first randomised controlled trial of adjunctive Liraglutide treatment in patients with diabetes mellitus after metabolic surgery. The results support the use of Liraglutide therapy in this clinical context. Funding: JP Moulton Charitable Foundation 3 surgery. We have previously shown that the acute peripheral administration of the GLP-1 RA Exendin-4 in rodent models of RYGB has additive effects to the already enhanced endogenous GLP-1 secretion as demonstrated by an additional reduction in food intake 11. Indeed, data from retrospective non-randomised studies in humans support this hypothesis: the administration of GLP-1 RAs in patients with and without T2DM and a suboptimal response to metabolic surgery was associated with weight loss and glycaemic improvements 12-15. This RCT was therefore designed to investigate the safety and efficacy of pharmacological administration of the GLP-1 RA Liraglutide on glycaemic control in patients with persistent or recurrent T2DM after RYGB or VSG surgery. Methods Study population This was a prospective randomised double-blinded placebo-controlled clinical trial. Eighty patients with obesity and persistent or recurrent T2DM that had undergone RYGB or VSG surgery at least 12 months before randomisation were recruited from the

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“…Furthermore, upcoming research may examine the use of novel bridging interventions, such as medical therapies, prior to bariatric surgery in patients with BMI ≥ 50 kg/m 2 . Currently, the use of substances such as liraglutide and naltrexone have been used proceeding bariatric surgery to induce additional weight loss, but it may be an area of interest to investigate its role in preoperative weight loss before bariatric surgery [40].…”

Section: Discussionmentioning

confidence: 99%

Bridging interventions before bariatric surgery in patients with BMI ≥ 50 kg/m2: a systematic review and meta-analysis

et al. 2019

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Background Bariatric surgery on patients with body mass index (BMI) ≥ 50 kg/m 2 , historically known as superobesity, is technically challenging and carries a higher risk of complications. Bridging interventions have been introduced for weight loss before bariatric surgery in this population. This systematic review and meta-analysis aims to assess the efficacy and safety of bridging interventions before bariatric surgery in patients with BMI ≥ 50 kg/m 2 . Methods MEDLINE, EMBASE, Web of Science, and Scopus were searched from database inception to September 2018. Studies were eligible for inclusion if they conducted any bridging intervention for weight loss in patients with BMI greater than 50 kg/m 2 prior to bariatric surgery. Primary outcome was the change in BMI before and after bridging intervention. Secondary outcomes included comorbidity status after bridging interventions and resulting complications. Pooled mean differences (MD) were calculated using random effects meta-analysis. Results 13 studies including 550 patients met inclusion criteria (mean baseline BMI of 61.26 kg/m 2 ). Bridging interventions included first-step laparoscopic sleeve gastrectomy (LSG), intragastric balloon (IGB), and liquid low-calorie diet program (LLCD). There was a reduction of BMI by 12.8 kg/m 2 after a bridging intervention (MD 12.8, 95% CI 9.49-16.1, P < 0.0001). Specifically, LSG demonstrated a BMI reduction of 15.2 kg/m 2 (95% CI 12.9-17.5, P < 0.0001) and preoperative LLCD by 9.8 kg/m 2 (95% CI 9.82-15.4, P = 0.0006). IGB did not demonstrate significant weight loss prior to bariatric surgery. There was remission or improvement of type 2 diabetes, hypertension, and sleep apnea in 62.8%, 74.6%, and 74.6% of patients, respectively. Conclusions First-step LSG and LLCD are both safe and appropriate bridging interventions which can allow for effective weight loss prior to bariatric surgery in patients with BMI greater than 50 kg/m 2 .

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Use Of Liraglutide For Weight Loss In Patients With Prior Bariatric Surgery

Cited by 7 publications

References 0 publications

Pharmacotherapies for Post‐Bariatric Weight Regain: Real‐World Comparative Outcomes

Pharmacotherapies for Post‐Bariatric Weight Regain: Real‐World Comparative Outcomes

Adjunctive liraglutide treatment in patients with persistent or recurrent type 2 diabetes after metabolic surgery (GRAVITAS): a randomised, double-blind, placebo-controlled trial

Bridging interventions before bariatric surgery in patients with BMI ≥ 50 kg/m2: a systematic review and meta-analysis

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