GLP-1RAs offer comparable weight loss to bariatric surgery with fewer side effects
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Key takeaways:
- Total body weight loss with tirzepatide 15 mg was similar to Roux-en-Y (15.18% vs. 19.29%).
- There also was no significant difference between tirzepatide and one-anastomosis gastric bypass or sleeve gastrectomy.
PHILADELPHIA — Tirzepatide 15 mg produced similar weight loss results as bariatric surgery among patients with obesity but had a favorable safety profile, according to a presenter at the ACG Annual Scientific Meeting.
“Bariatric surgery has been proven to be effective in not just achieving weight loss but also maintaining significant weight loss,” Jena Velji-Ibrahim, MD, MSc, of Prisma Health and University of South Carolina School of Medicine, said. “However, it is associated with perioperative mortality with long-term adverse events.”
She continued: “Bariatric endoscopy has evolved to be a minimally invasive treatment option that’s safe and effective and bridges this treatment gap ... Pharmacotherapy, including the GLP-1 receptor agonists, have also revolutionized obesity management.”
With limited head-to-head comparisons between bariatric surgery, bariatric endoscopy and GLP-1RAs, Velji-Ibrahim and colleagues conducted a systematic review and network meta-analysis to contrast the efficacy and safety of the three options.
Using MEDLINE, Embase and Cochrane, they identified 34 randomized controlled trials comprised of 15,660 participants (BMI, 25-45 kg/m2) and including four bariatric surgeries, three bariatric endoscopies and four GLP-1RAs.
The primary outcome was percentage total weight loss, with safety among secondary outcomes.
Results showed Roux-en-Y gastric bypass resulted in the most significant percentage total body weight loss (19.29%; 95% CI, 17.69-20.89), with similar results reported for one-anastomosis gastric bypass (18.15%; 95% CI, 11.82-24.48) and tirzepatide 15 mg (15.18%; 95% CI, 12.66-17.7).
Moreover, there was no significant difference in weight loss between tirzepatide 15 mg and one-anastomosis gastric bypass [median difference (MD)] = 2.97%: 95% CI, –3.85 to 9.79) or between tirzepatide 15 mg and laparoscopic sleeve gastrectomy (MD = 0.43%; 95% CI, –3.34 to 4.21). Similar results were also reported between semaglutide 2.4 mg and endoscopic sleeve gastroplasty and transpyloric shuttle.
When comparing each treatment with placebo, Roux-en-Y gastric bypass ranked first with a probability of 97% for obesity management.
Endoscopic interventions had better side effect profiles compared with bariatric surgery, with no increased risk for mortality, intensive care or surgery. The most common side effects for GLP-1 RAs were nausea, vomiting, diarrhea and constipation.
“The GLP-1 receptor agonists have similar weight loss as bariatric surgery with favorable side effect profiles,” Velji-Ibrahim said. “And when we compare bariatric surgery to bariatric endoscopy, endoscopic sleeve and transpyloric shuttle offer a minimally invasive alternative with good weight loss outcomes and fewer side effects.”
She continued, “Future studies in this area could really explore the long-term outcomes as well as potential combination therapies to really optimize obesity treatment.”
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Velji-Ibrahim J, et al. Comparative efficacy and safety of bariatric surgery, bariatric endoscopy and GLP-1 receptor agonists in obesity management: A network meta-analysis. Presented at: ACG Annual Scientific Meeting; Oct. 25-30, 2024; Philadelphia (hybrid meeting).
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