Background

Glucagon-like peptide-1 receptor agonists (GLP1RA) are significant advancements in obesity treatment with studies finding 10-20% total body weight loss (%TBWL). The effectiveness of GLP1RA in both the preoperative and postoperative bariatric surgery setting remains unknown.

Methods

Retrospective study (n = 74) evaluating patients following bariatric surgery (sleeve gastrectomy or gastric bypass) prescribed preoperative or postoperative GLP1RA therapy. Patients lacking 1 year of data after either therapy were excluded. Primary outcome of interest: %TBWL from day of surgery weight and % weight loss(%WL) from day of initiation of GLP1RA therapy.

Results

Patient demographics: median age 55 years; 78% were female; 35% underwent SG. Common comorbidities included diabetes (69%), reflux (82%), and hypertension (81%). Fifty-one patients (69%) received postoperative therapy, 18 (24%) preoperative therapy, and 5 (7%) received both. 44% received semaglutide, 48% liraglutide, 5% dulaglutide, and 3% exenatide. In the postoperative cohort (n = 51), %TBWL at 1 year and 5 years was 25.3% and 20%, respectively (85% with 5-year follow-up). GLP1RA therapy began a median of 5 years post-operatively; %TWL 1-year following GLP1RA was 7.7% (n= 49); %WL at 2 years following GLP1RA was 6.1% (54% had follow-up data). In the preoperative cohort (n = 18), median length of therapy pre-op was 23 months. Median %WL at 1-year post-GLP1RA therapy was 1.5% with five patients experiencing weight gain. Excluding those, %WL was 2.6%.

Conclusions

Postoperative, not preoperative, GLP1RA therapy appears effective. Further research is needed to elucidate its role and effectiveness in this cohort.