GLP-1 agonists less effective in obese patients with prior laparoscopic sleeve gastrectomy
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Key takeaways:
- Revisional endoscopic sleeve gastroplasty outperformed GLP-1 agonists for laparoscopic sleeve gastrectomy patients who regained weight.
- GLP-1 agonists achieved less weight loss among these patients vs. controls.
VANCOUVER, British Columbia — Glucagon-like peptide 1 agonists were significantly less effective for weight loss among patients who underwent laparoscopic sleeve gastrectomy and regained weight, according to a presenter.
“Laparoscopic sleeve gastrectomy (LSG) has been a frequently performed bariatric surgery worldwide that results in significant weight loss, but around one-third of patients develop weight regain, warranting reintervention,” Firas Bahdi, MD, from the David Geffen School of Medicine at University of California, Los Angeles, told Healio. “Their options include repeating an invasive bariatric surgery, such as conversion to Roux-en-Y gastric bypass, which carries the risk of morbidity and chronic nutritional deficiencies, or re-sleeve gastrectomy, which carries a higher risk of leakage than primary surgery.”
He added: “Exploring minimally or noninvasive options, including anti-obesity medications or revisional endoscopic sleeve gastroplasty (R-ESG), seemed necessary.”
GLP-1 or glucose-dependent insulinotropic polypeptide (GIP) agonists, such as tirzepatide (Mounjaro, Eli Lilly) and semaglutide (Wegovy, Novo Nordisk), are among the most widely used anti-obesity medications, and “while these medications were proven efficacious in patients with normal stomach, their efficacy in patients with prior LSG is unclear,” Bahdi noted.
To determine which minimally invasive option — GLP-1/GIP agonists or R-ESG — was more effective for patients who regain weight following LSG, Bahdi and colleagues conducted a retrospective study of patients with a history of LSG at UCLA Health who were treated with subcutaneous semaglutide or tirzepatide (n = 68; mean age, 52.9 years) or underwent R-ESG (n = 20; mean age, 45.2 years) for weight regain from January 2019 to January 2023. The researchers also identified a propensity-matched control group of obese patients (n = 87; mean age, 51.6 years) treated with GLP-1/GIP agonists without previous bariatric surgery.
Notable primary outcomes included total body weight loss, excess weight loss and adverse events on follow-up, with secondary outcomes including changes in A1c and lipid panel.
According to study results presented at ACG Annual Scientific Meeting, R-ESG achieved a significantly higher total body weight loss compared with GLP-1/GIP agonists at 3 months (10% vs. 4.3%; P = .0001) and 6 months (11.5% vs. 6.8%; P = .03) among LSG patients. Additionally, GLP-1/GIP agonists were found to attain significantly lower total body weight loss in LSG patients vs. controls at 3 months (4.3% vs. 5.7%; P = .02), 6 months (6.8% vs. 9.2%; P = .02) and 12 months (9.2% vs. 12.7%; P = .03).
“Our study results had two important findings: The first is that R-ESG offers significantly more weight loss than GLP-1/GIP agonists in LSG patients who regained weight while avoiding the challenges of medication refills and nonadherence,” Bahdi told Healio. “The second is that the GLP-1/GIP agonists achieve significantly less weight loss in obese patients with prior LSG compared to those with normal stomachs.”
The researchers observed that patients who underwent LSG followed by R-ESG exhibited significantly higher postoperative abdominal pain compared with patients received GLP-1/GIP agonists (10% vs. 0%; P = .04), yet no significant differences in other adverse events. Additionally, they reported no significant difference between patients who underwent LSG plus R-ESG vs. LSG plus GLP-1/GIP agonists in change of A1c (0.05 vs. 0.6), LDL (–8 vs. –1.1) or triglyceride levels (15.2 vs. 27.6) at 12 months.
“For obese patients with prior LSG who regain weight and are exploring minimally invasive weight loss options, our study supports R-ESG over GLP-1/GIP agonists as a more effective weight loss option that also spares patients and physicians the challenges of medications refills, prior authorizations and nonadherence,” Bahdi said.
He added: “Based on our data, we believe that gastroenterologists who perform endo-bariatric interventions or manage obesity and fatty liver disease should advocate for R-ESG over GLP-1/GIP agonists in patients who regain weight after LSG. They should also identify local endo-bariatric experts and collaborate with them for a comprehensive and possibly more effective care of these patients.”
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Bahdi F, et al. Outcomes of anti-obesity glucagon-like peptide 1 agonists vs. revisional endoscopic sleeve gastroplasty for weight regain after laparoscopic sleeve gastrectomy: A case-control real world experience. Presented at: ACG Annual Scientific Meeting; Oct. 20-25, 2023; Vancouver, British Columbia (hybrid meeting).
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