Abstract：
BACKGROUND: A significant number of patients face the issue of weight gain (WG) or inadequate weight loss (IWL) post-bariatric surgery for obesity. Several studies have been published evaluating the role of glucagon-like peptide-1 receptor agonists (GLP1RA) for weight loss post-bariatric surgery. However, no systematic review and meta-analysis (SRM) till date has evaluated the efficacy, safety and tolerability of GLP1RA in this clinical scenario. Hence, this SRM aimed to address this knowledge gap.
METHODS: Databases were searched for randomized controlled trials (RCTs), case-control, cohort and observational studies involving use of GLP1RA in the intervention arm post-bariatric surgery. Primary outcome was weight loss post at least 3 months of therapy. Secondary outcomes were evaluation of body composition parameters, total adverse events (TAEs) and severe adverse events (SAEs).
RESULTS: From initially screened 1759 articles, 8 studies (557 individuals) were analysed. Compared to placebo, patients receiving liraglutide had significantly greater weight loss after 6-month therapy [MD - 6.0 kg (95% CI, - 8.66 to - 3.33); P < 0.001; I2 = 79%]. Compared to liraglutide, semaglutide had significantly greater percent reduction in body weight after 6-month [MD - 2.57% (95% CI, - 3.91 to - 1.23); P < 0.001; I2 = 0%] and 12-month [MD - 4.15% (95% CI, - 6.96 to - 1.34); P = 0.004] therapy. In study by Murvelashvili et al. (2023), after 12-month therapy, semaglutide had significantly higher rates of achieving > 15% [OR 2.15 (95% CI, 1.07-4.33); P = 0.03; n = 207] and > 10% [OR 2.10 (95% CI, 1.19-3.71); P = 0.01; n = 207] weight loss. A significant decrease in fat mass [MD - 4.78 kg (95% CI, - 7.11 to - 2.45); P < 0.001], lean mass [MD - 3.01 kg (95% CI, - 4.80 to - 1.22); P = 0.001] and whole-body bone mineral density [MD - 0.02 kg/m2 (95% CI, - 0.04 to - 0.00); P = 0.03] was noted with liraglutide.
CONCLUSIONS: Current data is encouraging regarding use of GLP1RAs for managing WG or IWL post-bariatric surgery. Deterioration of bone health and muscle mass remains a concern needing further evaluation.
BACKGROUND: The predefined protocol has been registered in PROSPERO having registration number of CRD42023473991.
METHODS: Databases were searched for randomized controlled trials (RCTs), case-control, cohort and observational studies involving use of GLP1RA in the intervention arm post-bariatric surgery. Primary outcome was weight loss post at least 3 months of therapy. Secondary outcomes were evaluation of body composition parameters, total adverse events (TAEs) and severe adverse events (SAEs).
RESULTS: From initially screened 1759 articles, 8 studies (557 individuals) were analysed. Compared to placebo, patients receiving liraglutide had significantly greater weight loss after 6-month therapy [MD - 6.0 kg (95% CI, - 8.66 to - 3.33); P < 0.001; I2 = 79%]. Compared to liraglutide, semaglutide had significantly greater percent reduction in body weight after 6-month [MD - 2.57% (95% CI, - 3.91 to - 1.23); P < 0.001; I2 = 0%] and 12-month [MD - 4.15% (95% CI, - 6.96 to - 1.34); P = 0.004] therapy. In study by Murvelashvili et al. (2023), after 12-month therapy, semaglutide had significantly higher rates of achieving > 15% [OR 2.15 (95% CI, 1.07-4.33); P = 0.03; n = 207] and > 10% [OR 2.10 (95% CI, 1.19-3.71); P = 0.01; n = 207] weight loss. A significant decrease in fat mass [MD - 4.78 kg (95% CI, - 7.11 to - 2.45); P < 0.001], lean mass [MD - 3.01 kg (95% CI, - 4.80 to - 1.22); P = 0.001] and whole-body bone mineral density [MD - 0.02 kg/m2 (95% CI, - 0.04 to - 0.00); P = 0.03] was noted with liraglutide.
CONCLUSIONS: Current data is encouraging regarding use of GLP1RAs for managing WG or IWL post-bariatric surgery. Deterioration of bone health and muscle mass remains a concern needing further evaluation.
BACKGROUND: The predefined protocol has been registered in PROSPERO having registration number of CRD42023473991.
摘要：
背景：相当多的患者面临肥胖减肥手术后体重增加（WG）或体重下降不足（IWL）的问题。已经发表了一些研究，评估了胰高血糖素样肽1受体激动剂（GLP1RA）在减肥手术后体重减轻中的作用。然而,迄今为止，尚无系统评价和荟萃分析(SRM)评估疗效，在这种临床情况下，GLP1RA的安全性和耐受性。因此，本SRM旨在解决这一知识差距。
方法：在数据库中搜索随机对照试验（RCT），病例控制，涉及GLP1RA在减重手术后干预臂中使用的队列和观察性研究。主要结果是治疗至少3个月后体重减轻。次要结果是评估身体成分参数，总不良事件（TAEs）和严重不良事件（SAEs）。
结果：从最初筛选的1759篇文章中，分析了8项研究（557名个体）。与安慰剂相比，接受利拉鲁肽治疗的患者在治疗6个月后体重减轻显著[MD-6.0kg(95%CI,-8.66~-3.33);P<0.001;I2=79%].与利拉鲁肽相比,semaglutide治疗6个月后体重下降的百分比显著更大[MD-2.57%(95%CI,-3.91~-1.23);P<0.001;I2=0%]和12个月[MD-4.15%(95%CI,-6.96~-1.34);P=0.004].在Murvelashvili等人的研究中。(2023),经过12个月的治疗，semaglutide的体重减轻率>15%[OR2.15(95%CI,1.07~4.33);P=0.03;n=207]和>10%[OR2.10(95%CI,1.19~3.71);P=0.01;n=207].脂肪量显著下降[MD-4.78kg（95%CI，-7.11至-2.45）；P<0.001]，利拉鲁肽组的瘦体重[MD-3.01kg(95%CI,-4.80~-1.22);P=0.001]和全身骨密度[MD-0.02kg/m2(95%CI,-0.04~-0.00);P=0.03].
结论：目前关于使用GLP1RAs管理WG或IWL减肥手术后的数据令人鼓舞。骨骼健康和肌肉质量的恶化仍然是一个需要进一步评估的问题。
背景：预定义协议已在PROSPERO中注册，注册号为CRD42023473991。
方法：在数据库中搜索随机对照试验（RCT），病例控制，涉及GLP1RA在减重手术后干预臂中使用的队列和观察性研究。主要结果是治疗至少3个月后体重减轻。次要结果是评估身体成分参数，总不良事件（TAEs）和严重不良事件（SAEs）。
结果：从最初筛选的1759篇文章中，分析了8项研究（557名个体）。与安慰剂相比，接受利拉鲁肽治疗的患者在治疗6个月后体重减轻显著[MD-6.0kg(95%CI,-8.66~-3.33);P<0.001;I2=79%].与利拉鲁肽相比,semaglutide治疗6个月后体重下降的百分比显著更大[MD-2.57%(95%CI,-3.91~-1.23);P<0.001;I2=0%]和12个月[MD-4.15%(95%CI,-6.96~-1.34);P=0.004].在Murvelashvili等人的研究中。(2023),经过12个月的治疗，semaglutide的体重减轻率>15%[OR2.15(95%CI,1.07~4.33);P=0.03;n=207]和>10%[OR2.10(95%CI,1.19~3.71);P=0.01;n=207].脂肪量显著下降[MD-4.78kg（95%CI，-7.11至-2.45）；P<0.001]，利拉鲁肽组的瘦体重[MD-3.01kg(95%CI,-4.80~-1.22);P=0.001]和全身骨密度[MD-0.02kg/m2(95%CI,-0.04~-0.00);P=0.03].
结论：目前关于使用GLP1RAs管理WG或IWL减肥手术后的数据令人鼓舞。骨骼健康和肌肉质量的恶化仍然是一个需要进一步评估的问题。
背景：预定义协议已在PROSPERO中注册，注册号为CRD42023473991。
