Possible Role in Fatty Liver Disease Prevention
In another large multicenter study from the same institution, Ethan M. Cohen, MD, along with co-author Dr. Adekolu and others, compared the effectiveness of bariatric surgery to GLP-1 agonists for preventing nonalcoholic fatty liver disease (NAFLD). Since the study was conducted, the official name of NAFLD has changed to metabolic dysfunction–associated steatotic liver disease.
Dr. Cohen and colleagues evaluated data from the TriNetX database and included adults with a BMI of 35 or higher. They propensity matched 124,022 people who had sleeve gastrectomy or Roux-en-Y gastric bypass to another 124,022 others prescribed GLP-1 agonists. Again, they looked at outcomes at 3, 5, 7, and 10 years.
They found bariatric surgery superior to GLP-1 agonists for reducing the risk of developing NAFLD. Relative risk reduction was 25% at 3 years, 28% at 5 years, 27% at 7 years, and 26% at 10 years.
Although not to the same extent as surgery in this study, GLP-1–associated weight loss did reduce risks as well.
“An important aspect of this is that for some of these people, bariatric surgery is not even an option,” Dr. Cohen said in an interview, citing as an example those who do not meet the criteria for surgery.
Dr. Cohen and colleagues plan to continue the study with a larger number of participants.
Real-World Weight Regain
In another instance where a surgical procedure trumped GLP-1 agonists, revisional endoscopic sleeve gastroplasty (ESG) offered significantly higher weight loss than GLP-1 agonists among people who regained weight following initial weight-loss surgery, according to a case-control real-world study presented at the meeting.
“Laparoscopic sleeve gastrectomy [LSG] is a frequently performed bariatric surgery worldwide resulting in significant weight loss and improvement in obesity-related comorbidities,” said Firas Bahdi, MD, gastroenterology fellow at the David Geffen School of Medicine at University of California, Los Angeles. “Despite its success, around one third of patients, unfortunately, develop weight regain warranting intervention.”
Dr. Bahdi and colleagues retrospectively studied 68 adults prescribed subcutaneous semaglutide or tirzepatide after LSG, another 20 who had ESG for weight regain after LSG, and 87 controls with intact stomachs who also took GLP-1 agonists for weight loss.
They found that the ESG group experienced a significantly higher percentage of total body weight loss at 3 months than the GLP-1 group (10% vs 4.3%, respectively; P = .0001). Similarly, at the 6-month follow-up, the ESG group experienced 11.5% total body weight loss compared to 6.8% in the GLP-1 group (P = .03).
The GLP-1 after LSG group still fared better than the GLP-1 control group of people who never had surgery. Total body weight loss was 4.3% vs 5.7% at 3 months (P = .02), 6.8% vs 9.2% at 6 months (P = .02), and 9.2% vs 12.7% at 12 months (P = .03).
“In this real-world experience, revisional ESG offers significantly more weight loss than GLP-1 agonists for patients with weight regain, while also avoiding the challenges of medication refills, making it an attractive option,” Dr. Bahdi said.
Future multicenter studies are warranted to confirm these results and explore physiological explanations, he added.
The study received an Outstanding Research Award in the Obesity Category (Trainee).
Dr. Velji-Ibrahim, Dr. Adekolu, Dr. Cohen, and Dr. Bahdi indicated no relevant financial relationships.
A version of this article appeared on Medscape.com.