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利拉鲁肽和司美格鲁肽作为减重手术后体重反弹的治疗药物的疗效:一项回顾性观察研究。

Efficacy of the Glucagon-Like Peptide-1 Receptor Agonists Liraglutide and Semaglutide for the Treatment of Weight Regain After Bariatric surgery: a Retrospective Observational Study.

机构信息

Division of Endocrinology and Diabetes, Department of Internal Medicine, Cantonal Hospital of St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland.

Division of Surgery, Cantonal Hospital of St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland.

出版信息

Obes Surg. 2023 Apr;33(4):1017-1025. doi: 10.1007/s11695-023-06484-8. Epub 2023 Feb 11.

Abstract

PURPOSE

Weight regain after bariatric surgery occurs in up to a third of patients and reduces treatment-associated health benefits. The efficacy of glucagon-like peptide-1 receptor agonists (GLP1-RA) for treatment of type 2 diabetes mellitus and obesity is well established, but their role in the treatment of weight regain after bariatric surgery remains to be defined.

MATERIALS AND METHODS

This was a single centre retrospective observational study conducted at a Swiss bariatric reference centre. Patients with 6 months of treatment with GLP1-RA, up until November 2021, due to weight regain after bariatric surgery were identified. Data on body weight and relevant clinical parameters were collected before and after 6 months of treatment with GLP1-RA. Data are presented as median (interquartile range).

RESULTS

Fifty patients (82% female) were included. Before GLP1-RA treatment (liraglutide, n=29; semaglutide, n=21), weight and BMI were 90.5 kg (83.4, 107.9) and 34.0 kg/m (31.7, 38.7), respectively, with a post-bariatric weight regain of 15.1% (10.6, 22.8) of total body weight and 4.6 kg/m (3.3, 6.2). After 6 months of GLP1-RA treatment, a reduction in weight and BMI of 8.8% (5.2, 11.4) of total body weight and 2.9 kg/m (1.8, 4.0) was observed (P value <0.0001), corresponding to 67.4% (40.4, 92.2) of the weight regain. No serious adverse events were reported.

CONCLUSION

For patients experiencing weight regain after bariatric surgery, two-thirds of the weight regain can be safely lost with GLP1-RA, providing clinicians with a therapeutic option for this clinical challenge, and highlights the need for a large-scale randomized clinical trial.

摘要

目的

减重手术后体重反弹的发生率高达三分之一,降低了与治疗相关的健康益处。胰高血糖素样肽-1 受体激动剂(GLP1-RA)治疗 2 型糖尿病和肥胖症的疗效已得到充分证实,但它们在治疗减重手术后体重反弹中的作用仍有待确定。

材料和方法

这是一项在瑞士减重参考中心进行的单中心回顾性观察研究。确定了 2021 年 11 月前因减重手术后体重反弹而接受 GLP1-RA 治疗 6 个月的患者。收集了 GLP1-RA 治疗前 6 个月和治疗后 6 个月的体重和相关临床参数数据。数据以中位数(四分位数范围)表示。

结果

共纳入 50 名患者(82%为女性)。在接受 GLP1-RA 治疗(利拉鲁肽,n=29;司美格鲁肽,n=21)之前,体重和 BMI 分别为 90.5kg(83.4,107.9)和 34.0kg/m(31.7,38.7),减重手术后体重反弹 15.1%(10.6,22.8),BMI 反弹 4.6kg/m(3.3,6.2)。接受 GLP1-RA 治疗 6 个月后,体重和 BMI 分别下降了 8.8%(5.2,11.4)和 2.9kg/m(1.8,4.0)(P 值<0.0001),相当于体重反弹的 67.4%(40.4,92.2)。未报告严重不良事件。

结论

对于减重手术后体重反弹的患者,GLP1-RA 可安全减轻三分之二的体重反弹,为临床医生提供了一种治疗这种临床挑战的选择,并强调了进行大规模随机临床试验的必要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5c2a/9918402/6e280803f08f/11695_2023_6484_Fig1_HTML.jpg

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