Arrowaili Arief
Department of Anesthesia and Surgery, Faculty of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, 13317, Saudi Arabia.
Obes Surg. 2025 May;35(5):1947-1960. doi: 10.1007/s11695-025-07856-y. Epub 2025 Apr 16.
There is a pressing requirement to formulate innovative approaches for addressing inadequate weight loss or recurrence in individuals following metabolic bariatric surgery (MBS). Glucagon-like peptide- 1 (GLP- 1) analogues such as liraglutide and semaglutide have been formulated for treating type 2 diabetes or managing obesity. In this systematic review and meta-analysis, we aimed to pool the results from all available studies on GLP- 1 agonists to assess the efficacy of these drugs in weight recurrence or suboptimal clinical response of patients who underwent MBS.
We searched PubMed, Scopus, and Web of Science from inception till October 2024 for articles that fulfil our eligibility to be included in the systematic review and meta-analysis investigating the use of GLP- 1 agonists in the management of weight recurrence or suboptimal clinical response in patients who underwent MBS. The search strategy was as follows: "Liraglutide" OR "Semaglutide" OR "Tirzepatide" OR "GLP- 1" OR "Glucagon like peptide" AND "Weight" AND "Bariatric" OR "Sleeve" OR "Banding" OR "Roux-en-Y bypass. We used the mean difference (MD) to compare between continuous variables at a confidence interval (CI) of 95%, and p-value of 0.05.
The use of GLP- 1 agonists (liraglutide, semaglutide, and tirzepatide) was associated with a statistically significant decrease in the weight of the included patients showing an overall MD = 8.07 kg (95%CI: 5.5, 10.64, p < 0.00001) and I = 44%, p = 0.04. Moreover, these drugs (liraglutide, and semaglutide) showed significantly reduced body mass index (BMI) after treatment with overall MD = 4.42 kg/m (95%CI: 3.42, 5.42, p < 0.00001), and I = 67%, p = 0.0005. Compared with control group, the use of GLP- 1 agonists was associated with reduced weight with MD = - 9.19% (95%CI: - 10.81, - 7.58, p < 0.00001) and I = 0%. However, no difference was observed between both groups regarding BMI change with MD = - 1.97% (95%CI: - 4.65, 0.71, p = 0.15).
GLP- 1 agonists such as liraglutide and semaglutide effectively lower body weight and BMI in patients who suffer from weight recurrence or suboptimal clinical response after undergoing MBS. However, future studies are still warranted to investigate the most appropriate protocols for management.
迫切需要制定创新方法来解决代谢性减肥手术后个体体重减轻不足或复发的问题。利拉鲁肽和司美格鲁肽等胰高血糖素样肽-1（GLP-1）类似物已被用于治疗2型糖尿病或管理肥胖症。在这项系统评价和荟萃分析中，我们旨在汇总所有关于GLP-1激动剂的现有研究结果，以评估这些药物在接受代谢性减肥手术患者体重复发或临床反应欠佳方面的疗效。
我们检索了PubMed、Scopus和Web of Science数据库，从建库至2024年10月，查找符合纳入标准的文章，以进行关于GLP-1激动剂在管理接受代谢性减肥手术患者体重复发或临床反应欠佳方面的系统评价和荟萃分析。检索策略如下：“利拉鲁肽”或“司美格鲁肽”或“替尔泊肽”或“GLP-1”或“胰高血糖素样肽”与“体重”以及“减肥手术”或“袖状胃切除术”或“胃束带术”或“Roux-en-Y胃旁路术”。我们使用均数差（MD）在95%置信区间（CI）和p值为0.05的情况下比较连续变量。
使用GLP-1激动剂（利拉鲁肽、司美格鲁肽和替尔泊肽）与纳入患者体重的统计学显著下降相关，总体均数差=8.07千克（95%CI：5.5，10.64，p<0.00001），I²=44%，p=0.04。此外，这些药物（利拉鲁肽和司美格鲁肽）治疗后体重指数（BMI）显著降低，总体均数差=4.42千克/米²（95%CI：3.42，5.42，p<0.00001），I²=67%，p=0.0005。与对照组相比，使用GLP-1激动剂与体重减轻相关，均数差=-9.19%（95%CI：-10.81，-7.58，p<0.00001），I²=0%。然而，两组在BMI变化方面未观察到差异，均数差=-1.97%（95%CI：-4.65，0.71，p=0.15）。
利拉鲁肽和司美格鲁肽等GLP-1激动剂可有效降低接受代谢性减肥手术后体重复发或临床反应欠佳患者的体重和BMI。然而，仍需要未来的研究来探讨最合适的管理方案。
