Abdallah Hussein, Klink Wissam Hadi, Derienne Joseph, Voican Cosmin, Perlemuter Gabriel, Courie Rodi, Dagher Ibrahim, Tranchart Hadrien
Department of Minimally Invasive Digestive Surgery, Antoine Béclère Hospital, AP-HP, 157 Rue de La Porte de Trivaux, 92141 Clamart, Clamart, France.
Department of Hepato-Gastroenterology and Nutrition, Antoine Béclère Hospital, AP-HP, 92140 Clamart, Clamart, France.
Obes Surg. 2025 Sep 6. doi: 10.1007/s11695-025-08210-y.
Bariatric surgery (BS) is the most effective treatment for severe obesity, but a significant proportion of patients experience insufficient weight loss (IWL) or weight regain. Glucagon-like peptide-1 receptor agonists (arGLP-1) have emerged as a promising adjunctive therapy for managing these suboptimal outcomes. This study evaluates the efficacy and safety of arGLP-1 in patients with IWL or WR after BS.
A retrospective analysis was conducted on 100 patients who underwent BS (96 sleeve gastrectomy, 4 gastric bypass) and received arGLP-1 therapy (semaglutide or dulaglutide) for IWL (defined as < 50% excess weight loss (EWL) from baseline), and WR (a ≥ 10 kg increase from the nadir weight post-surgery). Data on weight loss, comorbidities, and adverse events were collected over a median follow-up of 1 year. Statistical analyses included paired t-tests, Wilcoxon signed-rank tests, and chi-squared tests.
At 1 year, patients achieved significant weight loss with a median total weight loss (%TWL) of 25.5% and a median excess weight loss (%EWL) of 66.3% compared to 16.6% and 40.8%, respectively, at treatment initiation with BMI reduction of 3.7 kg/m. Significant improvements were observed in comorbidities, including reductions in obstructive sleep apnea (- 30%), hypertension (- 40%), and arthralgia (- 56.5%). Glycated hemoglobin levels decreased by 0.8 points. Treatment was well-tolerated, with nausea being the most common side effect (5% discontinuation rate).
arGLP-1 are effective and safe for managing IWL or WR after BS, leading to significant weight loss, comorbidity improvement, and sustained %TWL. These findings support their use as a valuable adjunctive obesity management medication (OMMs) in post-bariatric care, though long-term adherence and cost-effectiveness require further investigation.
减肥手术（BS）是治疗重度肥胖最有效的方法，但相当一部分患者体重减轻不足（IWL）或体重反弹。胰高血糖素样肽-1受体激动剂（arGLP-1）已成为管理这些不理想结果的一种有前景的辅助治疗方法。本研究评估arGLP-1对减肥手术后出现IWL或体重反弹（WR）患者的疗效和安全性。
对100例行减肥手术（96例袖状胃切除术，4例胃旁路术）且因IWL（定义为自基线起超重减轻<50%（EWL））和WR（自手术后最低体重增加≥10 kg）接受arGLP-1治疗（司美格鲁肽或度拉糖肽）的患者进行回顾性分析。在中位随访1年期间收集体重减轻、合并症和不良事件的数据。统计分析包括配对t检验、Wilcoxon符号秩检验和卡方检验。
1年后，患者体重显著减轻，中位总体重减轻（%TWL）为25.5%，中位超重减轻（%EWL）为66.3%，而治疗开始时分别为16.6%和40.8%，BMI降低3.7 kg/m²。合并症有显著改善，包括阻塞性睡眠呼吸暂停减少（-30%）、高血压减少（-40%）和关节痛减少（-56.5%）。糖化血红蛋白水平下降0.8个百分点。治疗耐受性良好，恶心是最常见的副作用（停药率5%）。
arGLP-1对减肥手术后管理IWL或WR有效且安全，可导致显著体重减轻、合并症改善和持续的%TWL。这些发现支持其在减肥后护理中作为一种有价值的辅助肥胖管理药物（OMM）使用，不过长期依从性和成本效益需要进一步研究。
