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TOPLINE:

Neoadjuvant semaglutide administered before metabolic and bariatric surgery (MBS) did not improve overall weight loss or safety outcomes in patients with obesity and metabolic diseases.

METHODOLOGY:

• Semaglutide and other glucagon-like peptide-1 receptor agonists are effective in managing weight regain or insufficient weight loss after MBS; however, the long-term outcomes of using neoadjuvant semaglutide prior to MBS are unknown.
• Researchers conducted a retrospective case-control study at a multidisciplinary weight management center, matching patients who received neoadjuvant semaglutide to control individuals who did not receive semaglutide before MBS.
• The following parameters obtained from electronic health records were analyzed: Height, weight, A1c levels, operative time, and 30-day postoperative complications.

TAKEAWAY:

• Researchers assessed 182 patients (median age at surgery, 47 years; 76% women) receiving neoadjuvant semaglutide and 182 control individuals (median age at surgery, 44 years; 79% women).
• Participants received neoadjuvant semaglutide for a median of 24.4 weeks before MBS (median maximum dose, 1.0 mg per week), which resulted in a median total weight loss (TWL) of 4.0% before surgery.
• Patients who received semaglutide before MBS experienced a significantly higher percentage of TWL at 3 months than controls; however, TWL plateaued in the semaglutide group and improved in the control group at the 6-, 9-, and 12-month marks, with no significant differences between the groups.
• A1c levels and diabetes remission rates at 1-year postsurgery were not significantly different between the groups nor were early major postoperative complications and operative times.
• Postoperative surgical TWL at 1 year and TWL from preoperative semaglutide were not associated, with both good and poor MBS responders having similar weight loss with semaglutide.

IN PRACTICE:

“We are trying to figure out the best timing for these strategies to maximize their effectiveness and safety. When a patient should start the medicine, when they should stop taking it before surgery, and when they should have the surgery are things that still need to be evaluated,” the corresponding author of the study said in an accompanying press release.

SOURCE:

This study was led by Vasundhara Mathur, MD, Laboratory for Surgical and Metabolic Research, Brigham and Women’s Hospital, Harvard Medical School, Boston. It was published online in JAMA Surgery.

LIMITATIONS:

This study primarily included patients undergoing sleeve gastrectomy, potentially limiting generalizability to other surgical procedures. Semaglutide was used off-label for obesity until 2021, which may have resulted in suboptimal dosing. The study’s retrospective design may have introduced selection bias as patients with good response to semaglutide might have opted out of MBS.

DISCLOSURES:

No source of funding was reported for this study. One author reported being an advisory board member for Ethicon, another reported being a cofounder and consultant for AltrixBio, and a third declared receiving personal fees, nonfinancial support, and grants from certain institutions and pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.