Abstract：
OBJECTIVE: To compare the incidence of adverse events (AEs) related to antiobesity medications (AOMs; glucagon-like peptide-1 receptor agonists [GLP-1RAs] vs. non-GLP-1RAs) after bariatric surgery.
METHODS: This single-centre retrospective cohort included patients (aged 16-65 years) who had undergone laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy (cohort entry date) and initiated AOMs. Participants were categorized as users of US Food and Drug Administration (FDA)-approved, off-label, or GLP-1RA AOMs if documented as receiving the medication on or after cohort entry date. Non-GLP-1RA AOMs were phentermine, orlistat, topiramate, canagliflozin, dapagliflozin, empagliflozin, naltrexone, bupropion/naltrexone and phentermine/topiramate. GLP-1RA AOMs included: semaglutide, dulaglutide, exenatide and liraglutide. The primary outcome was AE incidence. Logistic regression was used to determine the association of AOM exposure with AEs.
RESULTS: We identified 599 patients meeting our inclusion criteria, 83% of whom were female. Their median (interquartile range [IQR]) age was 47.8 (40.9-55.4) years. The median duration of surgery to AOM exposure was 30 months. GLP-1RAs use was not associated with higher odds of AEs: adjusted odds ratio (aOR) 1.1 (95% confidence interval [CI] 0.5-2.6) and aOR 1.1 (95% CI 0.6-2.3) for GLP-1RA versus FDA-approved and off-label AOM use, respectively. AOM initiation ≥12 months after surgery was associated with lower risk of AEs compared to <12 months (aOR 0.01 [95% CI 0.0-0.01]; p < 0.001).
CONCLUSIONS: Our results showed that GLP-1RA AOMs were not associated with an increased risk of AEs compared to non-GLP-1RA AOMs in patients who had previously undergone bariatric surgery. Prospective studies are needed to identify the optimal timeframe for GLP-1RA initiation.
METHODS: This single-centre retrospective cohort included patients (aged 16-65 years) who had undergone laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy (cohort entry date) and initiated AOMs. Participants were categorized as users of US Food and Drug Administration (FDA)-approved, off-label, or GLP-1RA AOMs if documented as receiving the medication on or after cohort entry date. Non-GLP-1RA AOMs were phentermine, orlistat, topiramate, canagliflozin, dapagliflozin, empagliflozin, naltrexone, bupropion/naltrexone and phentermine/topiramate. GLP-1RA AOMs included: semaglutide, dulaglutide, exenatide and liraglutide. The primary outcome was AE incidence. Logistic regression was used to determine the association of AOM exposure with AEs.
RESULTS: We identified 599 patients meeting our inclusion criteria, 83% of whom were female. Their median (interquartile range [IQR]) age was 47.8 (40.9-55.4) years. The median duration of surgery to AOM exposure was 30 months. GLP-1RAs use was not associated with higher odds of AEs: adjusted odds ratio (aOR) 1.1 (95% confidence interval [CI] 0.5-2.6) and aOR 1.1 (95% CI 0.6-2.3) for GLP-1RA versus FDA-approved and off-label AOM use, respectively. AOM initiation ≥12 months after surgery was associated with lower risk of AEs compared to <12 months (aOR 0.01 [95% CI 0.0-0.01]; p < 0.001).
CONCLUSIONS: Our results showed that GLP-1RA AOMs were not associated with an increased risk of AEs compared to non-GLP-1RA AOMs in patients who had previously undergone bariatric surgery. Prospective studies are needed to identify the optimal timeframe for GLP-1RA initiation.
摘要：
目的：比较与抗肥胖药物（AOMs；胰高血糖素样肽-1受体激动剂[GLP-1RAs]和非GLP-1RAs）减肥手术后。
方法：这个单中心回顾性队列包括接受腹腔镜Roux-en-Y胃旁路术或袖状胃切除术（队列进入日期）并开始AOM的患者（年龄16-65岁）。参与者被归类为美国食品和药物管理局（FDA）批准的用户，标签外,或GLP-1RAAOM，如果记录为在队列进入日期或之后接受药物治疗。非GLP-1RAAOMs是芬特明，奥利司他,托吡酯,Canagliflozin,dapagliflozin,empagliflozin,纳曲酮,安非他酮/纳曲酮和苯丁胺/托吡酯。GLP-1RAAOMs包括：司马鲁肽，杜拉鲁肽,艾塞那肽和利拉鲁肽.主要结果是AE发生率。使用Logistic回归确定AOM暴露与AE的相关性。
结果：我们确定了599名符合我们纳入标准的患者，其中83％是女性。他们的中位年龄（四分位距[IQR]）为47.8（40.9-55.4）岁。AOM暴露手术的中位持续时间为30个月。GLP-1RAs的使用与较高的AE几率无关：GLP-1RA的调整比值比（aOR）1.1（95％置信区间[CI]0.5-2.6）和aOR1.1（95％CI0.6-2.3）与FDA批准的和标签外的AOM使用相比，分别。与<12个月相比，手术后≥12个月开始AOM与AE的风险较低相关（aOR0.01[95％CI0.0-0.01]；p<0.001）。
结论：我们的研究结果表明，在之前接受过减肥手术的患者中，与非GLP-1RAAOMs相比，GLP-1RAAOMs与AE风险增加无关。需要进行前瞻性研究以确定GLP-1RA启动的最佳时间范围。
方法：这个单中心回顾性队列包括接受腹腔镜Roux-en-Y胃旁路术或袖状胃切除术（队列进入日期）并开始AOM的患者（年龄16-65岁）。参与者被归类为美国食品和药物管理局（FDA）批准的用户，标签外,或GLP-1RAAOM，如果记录为在队列进入日期或之后接受药物治疗。非GLP-1RAAOMs是芬特明，奥利司他,托吡酯,Canagliflozin,dapagliflozin,empagliflozin,纳曲酮,安非他酮/纳曲酮和苯丁胺/托吡酯。GLP-1RAAOMs包括：司马鲁肽，杜拉鲁肽,艾塞那肽和利拉鲁肽.主要结果是AE发生率。使用Logistic回归确定AOM暴露与AE的相关性。
结果：我们确定了599名符合我们纳入标准的患者，其中83％是女性。他们的中位年龄（四分位距[IQR]）为47.8（40.9-55.4）岁。AOM暴露手术的中位持续时间为30个月。GLP-1RAs的使用与较高的AE几率无关：GLP-1RA的调整比值比（aOR）1.1（95％置信区间[CI]0.5-2.6）和aOR1.1（95％CI0.6-2.3）与FDA批准的和标签外的AOM使用相比，分别。与<12个月相比，手术后≥12个月开始AOM与AE的风险较低相关（aOR0.01[95％CI0.0-0.01]；p<0.001）。
结论：我们的研究结果表明，在之前接受过减肥手术的患者中，与非GLP-1RAAOMs相比，GLP-1RAAOMs与AE风险增加无关。需要进行前瞻性研究以确定GLP-1RA启动的最佳时间范围。
