The Potential of Semaglutide Once-Weekly in Patients Without Type 2 Diabetes with Weight Regain or Insufficient Weight Loss After Bariatric Surgery—a Retrospective Analysis

• DOI: 10.1007/s11695-022-06211-9
• Publication Date: 2022-07-25T19:02:52Z
• Authors: Anne Lautenbach; Marie Wernecke; Tobias B. Huber; Fabian Stoll; Jonas Wagner; Sebastian M. Meyh...; Svenja Meyhöfer; Jens Aberle
• Keywords: Glycated Hemoglobin; Original Contributions; Glucagon-Like Peptides; Bariatric Surgery; Weight Gain; Lipids; Glucagon-Like Peptide-1 Receptor; Obesity, Morbid; 3. Good health; 03 medical and health sciences; C-Reactive Protein; 0302 clinical medicine; Diabetes Mellitus, Type 2; Weight Loss; Humans; Prospective Studies; Triglycerides; Retrospective Studies

Abstract Purpose About 20–25% of patients experience weight regain (WR) or insufficient weight loss (IWL) after bariatric metabolic surgery (BS). Therefore, we aimed to retrospectively assess the effectiveness of adjunct treatment with the GLP-1 receptor agonist semaglutide in non-diabetic patients with WR or IWL after BS.

Materials and Methods Post-bariatric patients without type 2 diabetes (T2D) with WR or IWL (n = 44) were included in the analysis. The primary endpoint was weight loss 3 and 6 months after initiation of adjunct treatment. Secondary endpoints included change in BMI, HbA1c, lipid profile, hs-CRP, and liver enzymes.

Results Patients started semaglutide 64.7 ± 47.6 months (mean ± SD) after BS. At initiation of semaglutide, WR after post-bariatric weight nadir was 12.3 ± 14.4% (mean ± SD). Total weight loss during semaglutide treatment was − 6.0 ± 4.3% (mean ± SD, p < 0.001) after 3 months (3.2 months, IQR 3.0–3.5, n = 38) and − 10.3 ± 5.5% (mean ± SD, p < 0.001) after 6 months (5.8 months, IQR 5.8–6.4, n = 20). At 3 months, categorical weight loss was > 5% in 61% of patients, > 10% in 16% of patients, and > 15% in 2% of patients. Triglycerides (OR = 0.99; p < 0.05), ALT (OR = 0.87; p = 0.05), and AST (OR = 0.89; p < 0.05) at baseline were negatively associated with weight loss of at least 5% at 3 months’ follow-up (p < 0.05).

Conclusion Treatment options to manage post-bariatric excess weight (regain) are scarce. Our results imply a clear benefit of adjunct treatment with semaglutide in post-bariatric patients. However, these results need to be confirmed in a prospective randomized controlled trial to close the gap between lifestyle intervention and revision surgery in patients with IWL or WR after BS.

Graphical abstract