Glucagon-Like Peptide-1 Receptor Agonists for the Treatment of Suboptimal Initial Clinical Response and Weight Gain Recurrence After Bariatric Surgery: a Systematic Review and Meta-analysis

📖 Top 20% JournalFeb 13, 2025Obesity surgery

Glucagon-Like Peptide-1 Drugs for Improving Poor Early Results and Weight Return After Weight-Loss Surgery: A Review and Analysis

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Abstract

Nineteen studies involving 1290 patients reported significant weight loss with glucagon-like peptide-1 receptor agonists after bariatric surgery.

Liraglutide resulted in a pooled total weight loss of 9.24%, equating to 8.56 kg after at least 3 months of treatment.
Semaglutide showed a total weight loss of 11.38%, or 11.62 kg, while tirzepatide led to a 15.50% weight loss, corresponding to 12.60 kg.
Weight loss with liraglutide varied over time, with 7.65% and 7.47 kg for ≤ 6 months, increasing to 10.80% and 9.72 kg for ≥ 12 months.
Semaglutide's effects included a 10.18% weight loss at 6 months and a 13.15% loss at 12 months, translating to 9.43 kg and 14.68 kg, respectively.
Significant reductions in biochemical markers such as triglycerides and glycated hemoglobin were observed following treatment.
Common adverse effects included nausea (23%) and vomiting (6%), with a discontinuation rate of 3% due to these effects.

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BACKGROUND: Suboptimal initial clinical response (SICR) and weight gain recurrence (WGR) are challenging issues following bariatric surgery. Recently, the promising weight loss effects of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have been applied to bariatric patients. We aimed to conduct a systematic review and meta-analysis to evaluate the efficacy and safety of GLP-1 RAs in the treatment of SICR and WGR after bariatric surgery.

METHODS: A literature search was performed across online databases. The primary outcomes were percentage of total weight loss (%TWL) and absolute weight loss. Secondary outcomes included changes in biochemical markers and adverse effects (AEs).

RESULTS: Nineteen studies including 1290 patients were included. After at least 3 months of treatment, the pooled %TWL was 9.24% for liraglutide, 11.38% for semaglutide, and 15.50% for tirzepatide, with corresponding weight reductions of 8.56 kg, 11.62 kg, and 12.60 kg, respectively. Additionally, %TWL and weight loss with liraglutide use were 7.65% and 7.47 kg for ≤ 6 months, 10.22% and 9.30 kg for 6-12 months, and 10.80% and 9.72 kg for ≥ 12 months. For semaglutide, the %TWL and weight reduction were 10.18% and 9.43 kg at 6 months, and 13.15% and 14.68 kg at 12 months. Biochemical markers including triglycerides, total cholesterol, low-density lipoprotein cholesterol, glycated hemoglobin, and alanine aminotransferase levels showed significant reductions after GLP-1 RA treatment. Common AEs were nausea (23%), vomiting (6%), diarrhea (6%), constipation (10%), headache (6%), fatigue (8%), abdominal pain (2%), and abdominal bloating (2%). The proportion of patients who discontinued the treatment due to AEs was 3%.

CONCLUSIONS: GLP-1 RAs are effective and safe for treating SICR and WGR after bariatric surgery.

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