Treatment of obesity with GLP-1 receptor agonist after bariatric surgery: Real-world evidence.

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±6.3kg/m. 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±0.5mg/day) and 65% semaglutide (SEMA) (1.0±0.8mg/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.