Tratamiento de la obesidad después de la cirugía bariátrica con análogos del receptor de GLP-1: evidencia en vida real

IF 2.1 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Medicina Clinica Pub Date : 2025-08-27 DOI:10.1016/j.medcli.2025.107153

Camila Milad , Sergio Logwin , Nerea Antón , Amanda Jiménez , Lilliam Flores , Ainitze Ibarzábal , Violeta Moizé , Adriana Pané , Josep Vidal , Ana de Hollanda

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引用次数: 0

Abstract

Introduction

Approximately 25–30% of patients undergoing bariatric surgery (BS) experience weight regain or suboptimal weight loss. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have emerged as a therapeutic option in these cases.

Aim

To evaluate the effectiveness of GLP-1 RAs in managing weight regain and suboptimal weight response after BS in a real-world setting.

Materials and Methods

Retrospective study of BS patients treated with GLP-1 RAs due to weight regain or suboptimal weight response.

Results

A total of 953 patients underwent BS between 2015 and 2020; 122 initiated treatment with GLP-1 RAs. The cohort was composed 78% women, with a mean age of 50.4 ± 10.6 years and a baseline BMI of 44.7 ± 6.3 kg/m². At the start of treatment, 41.9 ± 20.5 months post-BS, the mean weight loss was 18.6 ± 10%; 52% had lost < 20% of their initial weight and 82% had regained > 20% of the weight lost. 35% received liraglutide (LIRA) (1.8 ± 0.5 mg/day) and 65% semaglutide (SEMA) (1.0 ± 0.8 mg/week), with a mean treatment duration of 19.3 ± 17.3 months. Maximum weight loss was 4.7 ± 4.8% with LIRA vs. 8.3 ± 5.9% with SEMA (p = 0.01). Total weight loss (BS + GLP-1 RA) was 21.6 ± 9.2% with LIRA vs. 25.6 ± 10.5% with SEMA. The proportion of patients with a suboptimal weight response after BS + pharmacotherapy (< 20%) significantly decreased (from 52% to 31%).

Conclusions

SEMA led to greater weight reduction than LIRA, positioning it as a more effective option for managing post-BS weight regain.

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减肥手术后使用GLP-1受体类似物治疗肥胖：现实生活中的证据

大约25-30%的接受减肥手术（BS）的患者体重恢复或体重下降不理想。胰高血糖素样肽-1受体激动剂（GLP-1 RAs）已成为这些病例的治疗选择。目的评估GLP-1 RAs在控制BS后体重恢复和次优体重反应中的有效性。材料与方法回顾性研究因体重恢复或体重反应不佳而接受GLP-1 RAs治疗的BS患者。结果2015 - 2020年共953例BS患者；122人开始用GLP-1 RAs治疗。该队列由78%的女性组成，平均年龄50.4±10.6岁，基线BMI为44.7±6.3 kg/m2。治疗开始时，bs后41.9±20.5个月，平均体重减轻18.6±10%；52%的人减掉了原来体重的20%，82%的人恢复了原来体重的20%。35%的患者接受利拉鲁肽（LIRA）（1.8±0.5 mg/天）和65%的患者接受西马鲁肽（SEMA）（1.0±0.8 mg/周）治疗，平均治疗时间为19.3±17.3个月。LIRA组最大体重减轻4.7±4.8%，而SEMA组最大体重减轻8.3±5.9% （p = 0.01）。总体重减轻（BS + GLP-1 RA） LIRA组为21.6±9.2%，SEMA组为25.6±10.5%。BS +药物治疗后体重反应不佳的患者比例（20%）显著下降（从52%降至31%）。结论：sema比LIRA更能减轻体重，使其成为治疗bs后体重反弹的更有效选择。

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

Medicina Clinica 医学-医学：内科

CiteScore

3.10

自引率

5.10%

发文量

295

审稿时长

22 days

期刊介绍： Medicina Clínica, fundada en 1943, es una publicación quincenal dedicada a la promoción de la investigación y de la práctica clínica entre los especialistas de la medicina interna, así como otras especialidades. Son características fundamentales de esta publicación el rigor científico y metodológico de sus artículos, la actualidad de los temas y, sobre todo, su sentido práctico, buscando siempre que la información sea de la mayor utilidad en la práctica clínica.