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

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.