Endoscopic Sleeve Gastroplasty Plus Obesity Drugs Add Up to More Weight Loss

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Endoscopic Sleeve Gastroplasty Plus Obesity Drugs Add Up to More Weight Loss

Anti-obesity medications and endoscopic sleeve gastroplasty (ESG) are popular strategies for weight loss on their own. Now researchers are looking at what happens when you combine them.

In a study presented at Digestive Disease Week (DDW) 2023, they found ESG followed by an anti-obesity medication led to more total weight loss than ESG alone.

Starting medication within 6 months of ESG was more ideal than other timing intervals. Initiating medical therapy more than 6 months before ESG was associated with less weight loss.

In the single-center, retrospective study, 224 patients were enrolled, of whom 34% were on monotherapy (ESG alone), 31% had combination therapy (medication prescribed within 6 months prior to or after ESG), and 35% had sequential therapy (medication more than 6 months prior to or after ESG).

Most patients were female, ranging from 74% to 95% of each group, and baseline BMI ranged from a mean 37.5 kg/m2 to 40.1 kg/m2.

The medications involved in the study were phenterminephentermine/topiramate ER (Qsymia), orlistat (Xenical, Alli), bupropion/naltrexone ER (Contrave), or the glucagon-like peptide-1 receptor agonist (GLP-1RA) liraglutide (Saxenda, Victoza) or semaglutide (Ozempic, Wegovy, Rybelsus). Of the patients who underwent combination therapy, 30% were prescribed a regimen that included a GLP-1RA. Of the patients who underwent sequential therapy, 81% were prescribed a medication first and 19% underwent ESG first.

At 1 year, the greatest total weight loss was a mean 23.7% with the combination of ESG and a GLP-1RA. Total weight loss was 18% with ESG plus a non-GLP-1RA medication. ESG alone led to 17.3%. Sequential therapy that began with ESG yielded 14.7% total weight loss, whereas sequential therapy that began with medication first resulted in 12% weight loss.

The serious adverse event (SAE) rate associated with ESG was similar among the three cohorts: 2.6% with monotherapy group, 1.4% with combination therapy, and 1.3% with sequential therapy. SAEs associated with anti-obesity medication occurred in 1.3% of the sequential therapy group and was not reported in either of the other two groups.

Digestive Disease Week (DDW) 2023. Abstracts 701 and 703.
Presented May 8, 2023.

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