Meta-analysis of randomized controlled trials for the development of the International Federation for Surgery of Obesity and Metabolic Disorders-European Chapter (IFSO-EC) guidelines on multimodal strategies for the surgical treatment of obesity.

IF 5.4 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes, Obesity & Metabolism Pub Date : 2025-04-08 DOI:10.1111/dom.16352

Maurizio De Luca, Amanda Belluzzi, Luigi Angrisani, Giulia Bandini, Barbara Becattini, Marco Bueter, Francesco Maria Carrano, Sonja Chiappetta, Ricardo V Cohen, Catalin Copaescu, Nicola Di Lorenzo, Marloes Emous, Daniel Moritz Felsenreich, Martin Fried, Jacques Himpens, Antonio Iannelli, Giuseppe Navarra, Simon Nienhuijs, Stefano Olmi, Chetan Parmar, Gerhard Prager, Juan Pujol-Rafols, Benedetta Ragghianti, Rui Ribeiro, Elena Ruiz-Úcar, Nasser Sakran, Paulina Salminen, Daniele Scoccimarro, Erik Stenberg, Christine Stier, Halit Eren Taskin, Ramón Vilallonga Puy, Matteo Monami

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引用次数: 0

Abstract

Background: Randomized, controlled trials (RCTs) comparing the effectiveness of metabolic bariatric surgery (MBS) in addition to one or more treatment interventions for obesity (i.e., lifestyle structured interventions-LSI, medical therapy-MT, obesity management medication-OMM or endobariatric procedures-EP) are lacking. This study aims to assess the effectiveness of multiple simultaneous (before or immediately after MBS) interventions for treating obesity.

Methods: We performed a meta-analysis including all RCTs enrolling patients undergoing different MBS procedures add-on to other anti-obesity strategies (LSI, MT, OMM or ES) versus MBS alone, with a duration of at least 6 months. The primary outcome was BMI at the end-point; secondary end-points included percentage total and excess weight loss (%TWL%, and EBWL%), total weight loss (TWL), fasting plasma glucose (FPG), HbA1c, surgical and non-surgical severe adverse events (SAE), mortality, remission of type 2 diabetes, hypertension, dyslipidemia and health-related quality of life (HR-QoL).

Results: A total of 25 RCTs were retrieved. The addition of either OMM (i.e., liraglutide) or EP (i.e., intragastric balloon-IB, endosleeve-ES) to MBS was associated with a significantly lower BMI at the end-point (p = 0.040). The addition of liraglutide only to MBS was associated with a greater %EWL%, but not %TWL and TBWL (p = 0.008). Three trials evaluated end-point HbA1c, showing a significant reduction in favour of liraglutide as an add-on therapy to MBS (p = 0.007). There was no mortality.

Conclusions: MBS combined with non-surgical approaches appears more effective than MBS alone in reducing BMI. Further RCTs on combined therapies to MBS for severe obesity are needed to enhance the tailoring of treatment for severe obesity.

查看原文本刊更多论文

国际肥胖和代谢疾病外科联合会-欧洲分会（IFSO-EC）关于肥胖手术治疗多模式策略指南的随机对照试验的荟萃分析。

背景：目前缺乏比较代谢减肥手术（MBS）与一种或多种肥胖治疗干预（即生活方式结构化干预- lsi、药物治疗- mt、肥胖管理药物- omm或减肥内手术- ep）的有效性的随机对照试验（rct）。本研究旨在评估多重同时（在MBS之前或之后）干预治疗肥胖的有效性。方法：我们进行了一项荟萃分析，包括所有随机对照试验，纳入接受不同MBS手术和其他抗肥胖策略（LSI， MT， OMM或ES）与单独MBS的患者，持续时间至少为6个月。主要终点是BMI；次要终点包括总体重减轻百分比和超重体重减轻百分比（%TWL%和EBWL%）、总体重减轻百分比（TWL）、空腹血糖（FPG）、糖化血红蛋白（HbA1c）、手术和非手术严重不良事件（SAE）、死亡率、2型糖尿病缓解、高血压、血脂异常和健康相关生活质量（HR-QoL）。结果：共检索到25项rct。在MBS中加入OMM（即利拉鲁肽）或EP（即胃内气囊- ib，套管内- es）与终点BMI显著降低相关（p = 0.040）。仅在MBS中添加利拉鲁肽与较高的EWL%相关，而与%TWL和TBWL无关（p = 0.008）。三个试验评估了终点HbA1c，显示利拉鲁肽作为MBS附加治疗的显著降低（p = 0.007）。没有死亡。结论：MBS联合非手术入路在降低BMI方面比单独MBS更有效。需要进一步的随机对照试验，以联合治疗重度肥胖的MBS，以加强对重度肥胖治疗的定制。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Diabetes, Obesity & Metabolism 医学-内分泌学与代谢

CiteScore

10.90

自引率

6.90%

发文量

319

审稿时长

3-8 weeks

期刊介绍： Diabetes, Obesity and Metabolism is primarily a journal of clinical and experimental pharmacology and therapeutics covering the interrelated areas of diabetes, obesity and metabolism. The journal prioritises high-quality original research that reports on the effects of new or existing therapies, including dietary, exercise and lifestyle (non-pharmacological) interventions, in any aspect of metabolic and endocrine disease, either in humans or animal and cellular systems. ‘Metabolism’ may relate to lipids, bone and drug metabolism, or broader aspects of endocrine dysfunction. Preclinical pharmacology, pharmacokinetic studies, meta-analyses and those addressing drug safety and tolerability are also highly suitable for publication in this journal. Original research may be published as a main paper or as a research letter.