November 2023
Liraglutide benefits patients with suboptimal weight loss after metabolic surgery

Daily liraglutide resulted in an additional mean weight loss of 8% compared with placebo.

Despite the general effectiveness of metabolic surgery for patients with severe obesity, as many as one-quarter have suboptimal weight loss. In this British study, researchers tested liraglutide as an adjunct for 70 patients with suboptimal weight loss (i.e. less than 20% of body weight) following surgery and suboptimal GLP-1 response to eating (i.e. twofold increase or less); 65 had undergone sleeve gastrectomy and five had undergone Roux-en-Y gastric bypass. Mean weight loss following surgery was 7% from a mean baseline of 120.2 kg. Patients were randomised to liraglutide 3.0 mg daily by subcutaneous injection or saline control. The daily dose started at 0.6 mg and was increased each week by 0.6 mg as tolerated. All patients were counselled to adopt a 500-kcal (2.092 J) energy-deficit diet and encouraged to exercise.

At 24 weeks of follow up, intervention patients had lost an additional mean 8.8% of their body weight versus 0.5% for controls – a significant difference. A significantly greater percentage of intervention patients lost an additional 5% or more of their body weight (72% vs 9%). 

Comment: These results are encouraging for patients and helpful for clinicians who are asked about adjunct treatment for severe obesity following a suboptimal response to metabolic surgery (particularly sleeve gastrectomy). However, the overall response when including the initial weight loss from surgery (a mean of about 15% total), leaves room for further improvement.

Thomas L. Schwenk, MD, Professor Emeritus, Family and Community Medicine, University of Nevada School of Medicine, Reno, USA.

Mok J, et al. Safety and efficacy ofliraglutide, 3.0 mg, once daily vs placebo in patients with poor weight loss following metabolic surgery: the BARI-OPTIMISE randomized clinical trial. JAMA Surg 2023 Jul 26; e-pub (https://doi. org/10.1001/jamasurg.2023.2930).

This summary is taken from the following Journal Watch titles: General Medicine, Gastroenterology, Ambulatory Medicine.