Semaglutide induces weight loss for nonresponders to bariatric surgery
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Key takeaways:
- Adults who did not respond to bariatric surgery achieved an average 9.8% weight loss at 24 weeks with semaglutide.
- A 10% or greater weight loss was achieved by 36% of adults with a history of bariatric surgery.
Adults who initiated once-weekly semaglutide after not responding to bariatric surgery lost a similar amount of weight as those without a history of bariatric surgery, according to study findings published in Obesity.
In a retrospective analysis of adults with a BMI of 40 kg/m2 or higher who were prescribed once-weekly semaglutide 2.4 mg (Wegovy, Novo Nordisk), those who previously underwent bariatric surgery and did not lose a sufficient amount of weight or regained weight after the procedure lost 9.8% of their body weight at 24 weeks and achieved an excess weight loss of 23.2%.
“Semaglutide is an excellent alternative in patients who have failed bariatric surgery,” Antoine Avignon, MD, PhD, professor of nutrition at the University of Montpellier and head of the nutrition-diabetes department at the Montpellier University Hospital Center in France, told Healio. “Its effectiveness in this case is the same as in patients who have not had surgery. It should definitely be tried before considering a second surgery.”
Avignon and colleagues recruited 111 adults with severe obesity, defined as having a BMI of 40 kg/m2 or higher, who received semaglutide 2.4 mg once weekly for 24 weeks from April to October 2022. The study group included 36 adults who previously underwent bariatric surgery and had an excess weight loss of less than 50% at 18 months or regained weight after surgery, and 75 adults without a history of bariatric surgery. Age, sex, BMI, waist circumference, systolic blood pressure and heart rate were collected. Glutamic-oxaloacetic transaminase, HbA1c, blood lipids, C-reactive protein and fibrosis-4 (FIB-4) score were obtained through laboratory data. The primary endpoint of the study was the difference in total weight loss at 24 weeks between adults who previously had bariatric surgery and those who did not undergo surgery.
Of the bariatric surgery group, 71.8% underwent sleeve gastrectomy and the remaining adults had gastric bypass. The lowest mean weight adults reached after bariatric surgery was 96.1 kg, and the average weight regain of the group was 29.2 kg.
Adults who previously underwent bariatric surgery achieved a 9.8% weight loss and a 23.2% excess weight loss from baseline to 24 weeks (P < .001). Adults without a history of bariatric surgery lost 8.7% of their weight and achieved a 19.7% excess weight loss at 24 weeks (P < .001). There was no difference in weight loss or excess weight loss between the two groups. Avignon said this was surprising as people who do not achieve sufficient weight loss with bariatric surgery tend to be more refractory to weight loss in general.
“The clinical implication is definitively that semaglutide is a treatment option for people who have failed bariatric surgery,” Avignon said.
At 24 weeks, 72% of the bariatric surgery group lost at least 5% of their body weight, 36% achieved at least a 10% weight loss and 8% of the group lost 15% or more of their weight. The figures were similar in the group without a history of bariatric surgery, with 62% losing 5% or more body weight, 31% of the group losing at least 10% of their weight and 8% of the group achieving a 15% or greater weight loss at 24 weeks.
There were no differences between the two groups in BMI change or waist circumference. Both groups had similar reductions in HbA1c, LDL cholesterol, triglycerides and serum glutamic-oxaloacetic transaminase. A decrease in FIB-4 score was observed in adults who previously underwent bariatric surgery (P = .01), but not in those who never had surgery.
Avignon said more research with a larger study population and longer follow-up is needed.
“We could also consider a randomized study of patients who have failed bariatric surgery between a second surgery group and a drug treatment group,” Avignon said.
For more information:
Antoine Avignon, MD, PhD, can be reached at a-avignon@chu-montpellier.fr.
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