TOPLINE:

Naltrexone-bupropion achieved comparable weight loss in surgery-naive patients and those with suboptimal outcomes after metabolic and bariatric surgery (MBS). Effectiveness was observed across doses, with significant weight reduction even at submaximal dosing.

METHODOLOGY:

• Although naltrexone-bupropion was effective for primary obesity, postsurgical efficacy was less clear as such patients were excluded from key initial trials.
• This retrospective cohort study compared naltrexone-bupropion in surgery-naive patients and those with weight regain or insufficient weight loss after MBS using data obtained from medical records between 2016 and 2022.
• Patients underwent weekly dose escalation from 8 mg naltrexone/90 mg bupropion daily to a maintenance dose of 32 mg naltrexone/360 mg bupropion daily, with submaximal doses allowed based on response and side effects.
• The coprimary endpoints were percentage change in body weight and achievement of at least 5% body weight reduction from baseline at 4 and 12 months; secondary endpoints included reasons for discontinuation and adverse effects.

TAKEAWAY:

• Researchers included 151 patients starting naltrexone-bupropion: 111 surgery-naive patients (median age, 45 years; 77.5% women; median BMI, 34.9) and 40 post-MBS patients (median age, 51.5 years; 75.0% women; median BMI, 35.2).
• At 4 months, median weight loss was slightly higher than 6% in both groups, with at least 5% weight loss achieved by 58.5% in the surgery-naive group and 66.7% in the post-MBS group.
• At 12 months, median weight loss was 8.8% in the surgery-naive group and 10.0% in the post-MBS group (P = .39). Over 70% in each group achieved at least 5% weight loss.
• Treatment persistence was 46.9% for surgery-naive patients and 67.5% for post-MBS patients at 4 months, reducing to 38.5% and 63.0%, respectively, at 12 months. Efficacy was similar on maximal and submaximal doses.
• Gastrointestinal side effects were the leading cause of early discontinuation and second most common reason for submaximal dosing in both groups; nervous system adverse events occurred in six patients overall.

IN PRACTICE:

“Real-world data demonstrates that [naltrexone-bupropion] is as effective and safe in this population as in surgery-naive patients. Additionally, this effect was independent of dose, which could make the therapy more affordable and tolerable for a broader patient population,” the authors wrote.

SOURCE:

The study was led by Marie Yskout, University Hospitals, Leuven, Belgium. It was published online in International Journal of Obesity.

LIMITATIONS:

Limitations included the retrospective design and small sample size, particularly in submaximal-dose subgroups, as well as high rates of discontinuation and patients lost to follow-up.

DISCLOSURES:

No funding source was reported. One author disclosed serving as a clinical investigator and participating in speakers bureaus and advisory panels for various pharmaceutical and healthcare companies.

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