The effectiveness and safety of pharmaceuticals to manage excess weight post-bariatric surgery: a systematic literature review

Abstract

Objective: To systematically review the literature on weight management pharmaceutical use in patients who have had bariatric surgery. Methods: Google Scholar, Pubmed, Cochrane, Embase, Web of Science, and Clinical Trials were searched from inception to December 31st, 2018 inclusive. Results: Thirteen studies met inclusion and reported decreases in weight with the use of weight management medications in post-bariatric surgical patients. Five studies examined weight loss outcomes by the type of bariatric surgery procedure, and four of these studies observed less weight loss in patients who had undergone gastric sleeve compared to those who had roux-en-y bypass (n ¼ 3 papers) and adjustable gastric banding (n ¼ 1 paper) with medication use. Four studies compared the effectiveness of medications for weight management and observed slightly greater weight loss with the use of topiramate and phentermine as a monotherapy compared to other weight loss medications. Using a sub-sample of participants, authors observed less weight loss on metformin but not phentermine or topiramate for younger adults. Another post-hoc analysis in the same sample observed greater weight loss for older adults with liraglutide 1.8 mg. Side effects were reported in seven studies and were overall consistent with those previously reported in non-surgical populations. Conclusion: Results of this systematic review suggest pharmacotherapy may be an effective tool as an adjunct to diet and physical activity to support weight loss in post-bariatric surgery patients. However, due to most studies lacking a control or placebo group, more rigorous research is required to determine the efficacy of this intervention.

Consensus on pharmacological treatment of obesity in Latin America

“…Evidence is limited, and further clinical trials are required for pharmacological treatment for weight regain or insufficient weight loss after bariatric surgery. However, it may be useful to prevent and treat weight regain and increase weight loss when it becomes temporarily stagnant using a multidisciplinary approach (LE: C; R: IIa) 106–113 …”

“…Once the therapeutic objective is achieved, patients should be followed up and monitored regularly. If the weight loss is regained consider discontinuation, change of medication or association with another drug in addition to reviewing, reinforcing, and maintaining lifestyle changes 15,16,85,103–114 …”

“…However, it may be useful to prevent and treat weight regain and increase weight loss when it becomes temporarily stagnant using a multidisciplinary approach (LE: C; R: IIa). [106][107][108][109][110][111][112][113] The following parameters are suggested for follow-up purposes and to define treatment success:…”

Impact of Treatment with GLP1 Receptor Agonists, Liraglutide 3.0 mg and Semaglutide 1.0 mg, While on a Waiting List for Bariatric Surgery

“…Pharmacological treatment for obesity has been mainly focused on the setting of insufficient or inadequate postsurgical weight loss, weight plateau, or post-surgical weight regain [8][9][10]. In this regard, GLP1 receptor agonists have been the In this regard, GLP1 receptor agonists have been one of the most frequently evaluated drugs for weight treatment, but data are limited to small retrospective and observational studies with short-term follow-up (less than 6 months), reaching 3.4-9.7% weight loss, depending on the dose used [11][12][13][14][15].…”