Adjunctive GLP-1 RAs improve short-term weight loss after bariatric surgery, but not at 12 months

Despite the effectiveness of bariatric surgery in treating obesity and related comorbidities, some patients experience suboptimal weight loss or weight regain. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are powerful anti-obesity medications, but their optimal role as an adjunctive therapy post-bariatric surgery remains unclear. Current standard-of-care often relies on lifestyle modifications, leaving a gap for pharmacological interventions to enhance or maintain weight loss and metabolic control in the long term. This meta-analysis explores the efficacy and safety of adding GLP-1 RAs to post-surgical care.

Researchers conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing GLP-1 RAs with placebo after bariatric surgery. They searched PubMed, Embase, and Cochrane Central for relevant studies. Primary outcomes were changes in body weight (kg) and HbA1c (%) at 6 and 12 months. Secondary outcomes included percent total body weight loss (%TBWL), quality of life, and adverse events. Mean differences (MDs) with 95% confidence intervals (CIs) were pooled using random effects models. An exploratory subgroup analysis compared very early (≤ 2 months) versus late (≥ 18 months) initiation post-surgery.

Seven RCTs, involving a total of n=460 participants, met the inclusion criteria; all evaluated liraglutide. GLP-1 RAs significantly increased weight loss at 6 months (MD -5.33 kg; 95% CI -9.42 to -1.23; p=0.02). This effect, however, was not statistically significant at 12 months (MD -5.05 kg; 95% CI -22.14 to 12.05; p=0.33). Similarly, GLP-1 RAs increased %TBWL at 6 months (MD 5.13%; 95% CI 2.14 to 8.11; p=0.007), but not at 12 months (MD 3.96%; 95% CI -3.33 to 11.26; p=0.18).