Weight loss between glucagon‐like peptide‐1 receptor agonists and bariatric surgery in adults with obesity: A systematic review and meta‐analysis

Abstract

Objective Glucagon‐like peptide‐1 (GLP‐1) receptor agonists recently demonstrated 15% to 20% weight loss in adults with obesity, a range which has previously been achieved only with bariatric surgery. This systematic review and meta‐analysis compares weight loss between GLP‐1 receptor agonists and bariatric surgery. Methods The databases MEDLINE, MEDLINE In‐Process, MEDLINE Epubs Ahead of Print, Embase Classic + Embase (OvidSP), and Cochrane (Wiley) were searched from inception to April 21, 2021, for randomized controlled trials and observational studies. Two independent reviewers extracted data, reported risk of bias, and graded certainty of evidence. Random‐effects models were used to pool change in weight, BMI, and glycated hemoglobin. Results Six studies, encompassing 332 patients, were included. Among randomized controlled trials, mean difference in weight between all bariatric surgery types and GLP‐1 receptor agonists was −22.68 kg (95% CI: −31.41 to −13.96), mean difference in BMI was −8.18 kg/m2 (95% CI: −11.59 to −4.77), and mean difference in glycated hemoglobin was −1.28% (95% CI: −1.94% to −0.61%). Among observational studies, mean difference in weight was −25.11 kg (95% CI: −40.61 to −9.60), and mean difference in BMI was −10.60 kg/m2 (95% CI: −17.22 to −3.98). Only one observational study reported glycemic outcomes. Conclusion In adults with obesity, bariatric surgery still confers the highest reductions in weight and BMI but confers similar effects in glycemic control when compared with GLP‐1 receptor agonists.

Metabolic bariatric surgery as a therapeutic option for patients with type 2 diabetes: A meta‐analysis and network meta‐analysis of randomized controlled trials

“…In particular, a relevant body of evidence is available for the comparison of RYGB with SG, showing a greater efficacy of gastric bypass on glycaemic and other metabolic endpoints. This confirms the results of previous meta‐analyses reporting a greater efficacy of RYGB than SG for glycaemic control, lipid profile and BMI 3–5,7,75 . Fewer trials compared other surgical interventions, showing that malabsorptive techniques are more effective than restrictive interventions, with a comparable tolerability and safety.…”

“…On the other hand, in many available trials, the treatments used in the comparator arm did not include newer and more effective treatments, such as glucagon‐like peptide‐1 (GLP1) receptor agonists and dual GLP1‐gastric inhibitory polypeptide agonists 72–74 . Notably, a recent meta‐analysis comparing surgery with GLP1 receptor agonists showed greater efficacy of MBS on BW, but less on glycaemic control 75 . In addition, the reduction of HbA1c in MBS arms versus controls appeared to be smaller in trials with a longer duration, posing some concerns about the actual durability of this approach.…”

“…[72][73][74] Notably, a recent meta-analysis comparing surgery with GLP1 receptor agonists showed greater efficacy of MBS on BW, but less on glycaemic control. 75 In addition, the reduction of HbA1c in MBS arms versus controls appeared to be smaller in trials with a longer duration, posing some concerns about the actual durability of this approach. Further longer-term trials are needed to explore this point.…”

Effect of Glucagon-like Peptide-1 Receptor Agonists on Cardio-Metabolic Risk Factors among Obese/Overweight Individuals Treated with Antipsychotic Drug Classes: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…Overall, in the obesity population, GLP-1RAs appear as an efficacious and safe treatment option; however, in cases of morbid obesity, they seem to be inferior to bariatric surgery, which remains the treatment of choice [ 38 ]. However, since subjects with psychotic disorders have increased cardiovascular risk compared to healthy controls [ 6 ], while they also encounter substantial disparities in terms of CVD screening and treatment [ 39 ], it seems that GLP-1RAs appear as a reasonable treatment option, aiming at improving the cardio-metabolic health of those patients.…”

Is remission of type 2 diabetes mellitus real?

“…23 Although bariatric surgery has been found to confer greater weight loss than GLP-1 receptor agonists, the improvements in glycaemia are similar. 24 Sustained benefit requires ongoing medication use.…”