Naltrexone/Bupropion, Liraglutide, or Semaglutide as Adjuvant Therapy After Metabolic and Bariatric Surgery: An Observational Study.

Abstract

Introduction: Obesity is a chronic and relapsing disease and metabolic and bariatric surgery (MBS) provides the greatest weight loss efficacy to improve obesity related complications. However, weight recurrence and suboptimal weight loss occur in some patients leading to a recurrence of disease. Obesity management medications (OMM) to prevent and manage excess weight after MBS are now being recommended. The aim of the study was to determine the efficacy of OMM prescribed for recurrent weight gain (RWG) or suboptimal weight loss (SWL) after primary and conversional bariatric metabolic surgery.

Methods: Patients were prescribed either a fixed-dose extended-release combination of naltrexone and bupropion (NB-ER; 8 mg/90 mg), liraglutide (3.0 mg), or semaglutide (1.0 mg) for RWG and/or SWL following adjustable gastric banding (LAGB), sleeve gastrectomy (LSG), one anastomosis gastric bypass (OAGB), or conversional procedures. Data were reported as categorical values using either parametric or nonparametric statistics.

Results: For the 121 patients analyzed, baseline characteristics were similar at initiation of OMM. Among these patients, 59.7% underwent LSG, 11.8% underwent OAGB, 6.7% underwent LAGB, and 21.8% underwent conversional procedures. Patients regained a median of 9.7 kg (IQR; 5-18.1) or 27.9% (IQR; 15.7-57.8) of total body weight previously lost following MBS. In total, 34 patients (28.1%) were prescribed NB-ER, 23 patients (19.1%) were prescribed liraglutide, and 64 patients (52.8%) were prescribed semaglutide post MBS. Overall, patients prescribed OMM treatment lost 8.8% (IQR; 5.7-14.1; median follow-up, 9 months [IQR; 5-12]) total body weight. Adverse effects were minor and reflected clinical trial nonsurgical cohorts.

Conclusion: Adjuvant OMM conferred additional significant weight loss in patients with RWG or SWL in both primary and conversional surgical procedures and all three OMM studied should be considered as part of MBS aftercare.