Tirzepatide shows a mean difference of 4.23% weight loss over semaglutide at 6 monthsIncretin drugs may help patients after bariatric surgery

IntroductionMetabolic bariatric surgery is a highly effective weight-loss intervention. Nevertheless, a non-negligible proportion of patients experience a suboptimal clinical response, which may present as insufficient weight loss or weight regain after an initial loss. In these cases, weight management pharmacotherapy can be considered. We aimed to conduct a systematic review and meta-analysis of the best available data on the use of incretin receptor agonists, liraglutide, semaglutide, and tirzepatide, in patients previously submitted to metabolic bariatric surgery.MethodsWe searched PubMed, Scopus, and Web of Science, for original studies that evaluated weight loss and adverse events in adults submitted to metabolic bariatric surgery one year or more before receiving treatment with these drugs.ResultsTwenty-seven papers (n=27) were included in this systematic review, of which nineteen (n=19) were used in the meta-analysis. After treatment with incretin receptor agonists, patients who underwent metabolic bariatric surgery, experienced significant weight loss. Meta-analysis showed, at 12 months, a total weight loss of 9.22% with liraglutide and of 9.02% with semaglutide. At 6 months, a mean difference in total weight loss of 4.23% was presented in favor of tirzepatide as compared to semaglutide. No serious adverse events were observed and most reported side effects were non-serious, consisting primarily of mild gastrointestinal symptoms.DiscussionThis data suggests that incretin receptor agonist treatment after metabolic bariatric surgery demonstrated the ability to achieve significant weight loss with a good safety profile, particularly in patients with a suboptimal clinical response, and thus may serve as an alternative rescue therapy to revisional surgery. However, given the substantial heterogeneity across studies, these findings should be interpreted with caution.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022371697, identifier CRD42022371697.