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Glucagon-Like Peptide-1 Receptor Agonists in Post-bariatric Surgery Patients: A Systematic Review and Meta-analysis

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Abstract

Background

A significant number of patients face the issue of weight gain (WG) or inadequate weight loss (IWL) post-bariatric surgery for obesity. Several studies have been published evaluating the role of glucagon-like peptide-1 receptor agonists (GLP1RA) for weight loss post-bariatric surgery. However, no systematic review and meta-analysis (SRM) till date has evaluated the efficacy, safety and tolerability of GLP1RA in this clinical scenario. Hence, this SRM aimed to address this knowledge gap.

Methods

Databases were searched for randomized controlled trials (RCTs), case–control, cohort and observational studies involving use of GLP1RA in the intervention arm post-bariatric surgery. Primary outcome was weight loss post at least 3 months of therapy. Secondary outcomes were evaluation of body composition parameters, total adverse events (TAEs) and severe adverse events (SAEs).

Results

From initially screened 1759 articles, 8 studies (557 individuals) were analysed. Compared to placebo, patients receiving liraglutide had significantly greater weight loss after 6-month therapy [MD − 6.0 kg (95% CI, − 8.66 to − 3.33); P < 0.001; I2 = 79%]. Compared to liraglutide, semaglutide had significantly greater percent reduction in body weight after 6-month [MD − 2.57% (95% CI, − 3.91 to − 1.23); P < 0.001; I2 = 0%] and 12-month [MD − 4.15% (95% CI, − 6.96 to − 1.34); P = 0.004] therapy. In study by Murvelashvili et al. (2023), after 12-month therapy, semaglutide had significantly higher rates of achieving > 15% [OR 2.15 (95% CI, 1.07–4.33); P = 0.03; n = 207] and > 10% [OR 2.10 (95% CI, 1.19–3.71); P = 0.01; n = 207] weight loss. A significant decrease in fat mass [MD − 4.78 kg (95% CI, − 7.11 to − 2.45); P < 0.001], lean mass [MD − 3.01 kg (95% CI, − 4.80 to − 1.22); P = 0.001] and whole-body bone mineral density [MD − 0.02 kg/m2 (95% CI, − 0.04 to − 0.00); P = 0.03] was noted with liraglutide.

Conclusion

Current data is encouraging regarding use of GLP1RAs for managing WG or IWL post-bariatric surgery. Deterioration of bone health and muscle mass remains a concern needing further evaluation.

Trial Registration

The predefined protocol has been registered in PROSPERO having registration number of CRD42023473991.

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Authors and Affiliations

  1. Department of Endocrinology, Center for Endocrinology Diabetes Arthritis & Rheumatism (CEDAR) Superspeciality Healthcare, Dwarka, New Delhi, India

    Deep Dutta

  2. Department of Endocrinology, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, India

    Lakshmi Nagendra

  3. Department of Endocrinology, Bhaktivedanta Hospital, Mumbai, India

    Ameya Joshi

  4. Department of Pharmacy Practice, JSS College of Pharmacy, Mysuru, Karnataka, India

    Suryashri Krishnasamy

  5. Department of Rheumatology, CEDAR Superspeciality Healthcare, Dwarka, New Delhi, India

    Meha Sharma

  6. Department of Medicine/Endocrinology, Institute of Medicine, Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital, Kathmandu, Nepal

    Naresh Parajuli

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  1. Deep Dutta
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Correspondence to Deep Dutta.

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Highlights

• Glucagon-like peptide-1 receptor agonists are effective for weight loss in post-bariatric surgery.

• Six-month liraglutide therapy caused greater weight loss compared to placebo [MD − 6.0kg].

• Six-month semaglutide caused significantly greater percent reduction weight compared to liraglutide [MD − 2.57%].

• Weight loss–related bone mineral and muscle loss remain a concern.

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Dutta, D., Nagendra, L., Joshi, A. et al. Glucagon-Like Peptide-1 Receptor Agonists in Post-bariatric Surgery Patients: A Systematic Review and Meta-analysis. OBES SURG 34, 1653–1664 (2024). https://doi.org/10.1007/s11695-024-07175-8

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