The impact of glucagon-like peptide-1 receptor agonists (GLP-1 RA) on weight loss following bariatric treatment: a systematic review and meta-analysis

Abstract

Context: There has been growing recognition of the need for considering weight loss strategies following metabolic bariatric surgery (MBS) to limit the magnitude of potential weight regain. The use of glucagon-like peptide-1 receptor agonists (GLP-1 RA) in this setting remains uncertain.

Objective: We conducted a systematic review and meta-analysis to evaluate the effect of GLP-1 RA on weight changes in patients who previously underwent MBS.

Data sources: MEDLINE/PubMed, EMBASE, and Clinicaltrials.gov.

Study selection: Observational studies and randomized controlled trials (RCTs).

Data extraction: We examined the impact of GLP-1 RA on weight changes by calculating pooled estimates (random-effects model) of the absolute differences in bodyweight (kg) as compared to baseline for observational studies and as compared to control group for RCTs.

Data synthesis: Seventeen studies (1164 participants) met our inclusion criteria. Pooling the data from the 14 observational studies evaluating the effect of GLP-1 RA post-bariatric treatment demonstrated a reduction of 7.83 kg as compared to pre-treatment (before the use of GLP-1 RA) [weight - 7.83 kg (95%CI: -9.27 to -6.38)]. With respect to tolerability, 23% (95%CI: 10 to 36%) of participants reported any adverse event but only 7% discontinued treatment. Data from RCTs showed that the use of GLP-1 RA induced weight reduction of 4.36 kg (95%CI: -0.42 to -8.30), as compared to placebo with similar safety profile.

Conclusions: Our findings suggest that the use of liraglutide and semaglutide in patients who previously underwent MBS can promote significant weight reduction with acceptable safety profile.

Trial registration: CRD42023450024.

Keywords: GLP-1 RA; bariatric treatment; liraglutide; semaglutide; weight loss.