Unidade de Obesidade, Disciplina de Endocrinologia e Metabologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), R. Dr. Ovídio Pires de Campos, 225 - Cerqueira César, São Paulo, SP, 05403-010, Brazil.
Obes Surg. 2023 Sep;33(9):2941-2944. doi: 10.1007/s11695-023-06736-7. Epub 2023 Jul 19.
Bariatric surgery is the most efficient treatment for obesity. However, in some cases, weight regain can occur. Currently, it is unknown the best antiobesity medication (AOM) for such clinical situation. This study aims to evaluate the effect of AOM in patients with weight regain after bariatric surgery.
A retrospective cohort study from December 2010 to July 2019 with patients submitted to bariatric surgery that had weight regain and received AOM for at least 2 years.
Of 96 patients that had weight regain in the analyzed period and received AOM, 16 were excluded from the analysis due to non-compliance (n = 7), treatment failure (n = 5), intolerable side effects with all available AOM (n = 2), or interaction with other medications (n = 2). Eighty patients were included in the analysis. The mean age was 59.0 ± 10.1 years, 88.8% were female, 91.2% white, and most of them were submitted to gastric bypass (87.6%). The mean preoperative and nadir weight after surgery were 127.9 ± 25.5 kg and 84.7 ± 22.8 kg, respectively. At the initiation of AOM, the mean baseline weight was 99.4 ± 23.1 kg. After 2 years of follow-up, there was significant weight loss in the groups treated with topiramate-alone (- 3.2 kg), topiramate plus sibutramine (- 6.1kg), and orlistat-alone or in combination (- 3.9kg). No statistical difference was observed in the sibutramine-alone group.
Topiramate (alone or associated with sibutramine) and orlistat (alone or in combination) promoted significant weight loss after 2 years of use in patients submitted to bariatric surgery with weight regain.
减重手术是治疗肥胖症最有效的方法。然而，在某些情况下，体重可能会出现反弹。目前，对于这种临床情况，尚不清楚哪种减肥药（AOM）最有效。本研究旨在评估 AOM 在减重手术后体重反弹患者中的疗效。
这是一项回顾性队列研究，纳入 2010 年 12 月至 2019 年 7 月间接受减重手术且术后体重反弹并接受 AOM 治疗至少 2 年的患者。
在分析期间，96 例患者出现体重反弹并接受 AOM 治疗，其中 16 例由于不依从（n=7）、治疗失败（n=5）、不耐受所有可用 AOM 的副作用（n=2）或与其他药物相互作用（n=2）而被排除在分析之外。最终 80 例患者纳入分析。患者平均年龄为 59.0±10.1 岁，88.8%为女性，91.2%为白人，大多数患者接受胃旁路手术（87.6%）。术前和术后最低点体重分别为 127.9±25.5kg 和 84.7±22.8kg。在开始使用 AOM 时，基线体重的平均值为 99.4±23.1kg。随访 2 年后，单独使用托吡酯（-3.2kg）、托吡酯联合西布曲明（-6.1kg）和单独或联合使用奥利司他（-3.9kg）的患者体重均显著下降。而单独使用西布曲明的患者体重无明显下降。
在接受减重手术且术后体重反弹的患者中，托吡酯（单独使用或联合使用西布曲明）和奥利司他（单独使用或联合使用）在使用 2 年后体重显著下降。
