Key takeaways:
- No important variations had been reported in mortality and cardiovascular outcomes between surgical procedure and GLP-1 teams.
- The findings recommend GLP-1s should enhance outcomes for many who can not endure surgical procedure.
SAN DIEGO — Bariatric surgical procedure and GLP-1s conferred related outcomes in mortality, hostile cardiovascular occasions and cirrhosis improvement in sufferers with diabetes, weight problems and metabolic dysfunction-associated steatotic liver illness.
Nonetheless, sufferers who underwent bariatric surgical procedure had decrease threat for power kidney illness, whereas these on GLP-1s had higher hypertension outcomes, findings introduced at Digestive Illness Week confirmed.
“This inhabitants of sufferers with weight problems, diabetes, MASH or MASLD have advanced illness, and oftentimes one remedy received’t be sufficient, or they’ll have a relapse and also you’ll have to consider the next move,” C. Roberto Simons–Linares, MD, examine creator and director of bariatric endoscopy at Cleveland Clinic, advised Healio. “One of many take-home messages of this examine is that GLP-1s will be as useful as bariatric surgical procedure for impacting mortality and development of power liver illness and needs to be thought of as a possible instrument within the remedy toolbox.”
Strategies
Simons-Linares and colleagues carried out a retrospective cohort examine to check outcomes amongst sufferers with MASLD or metabolic dysfunction-associated steatohepatitis, weight problems (BMI 30 kg/m2) and kind 2 diabetes who underwent bariatric surgical procedure or acquired remedy with GLP-1s.
Eligible sufferers had been recognized utilizing the TriNetX database between Jan. 1, 2014, and Dec. 12, 2023.
The researchers propensity-matched sufferers within the bariatric surgical procedure group (n = 1,450) to these within the GLP-1 group (n = 30,788) primarily based on age, demographics, socioeconomic components, comorbidities and drugs. The evaluation included 1,441 sufferers in every cohort.
All-cause mortality, incidence of cirrhosis, main hostile cardiovascular occasions and power kidney illness at 5 and 10 years after intervention served as outcomes.
“The motivation behind this was to judge whether or not sufferers who may not have entry to the gold normal — bariatric surgical procedure — might use GLP-1s to deal with these ailments and see a profit,” Simons-Linares mentioned. “Oftentimes, these sufferers with advanced, power, relapsing ailments want multimodal remedy. There’s no one-size-fits-all.”
Outcomes
The researchers noticed no important variations in mortality and main cardiovascular outcomes between the 2 cohorts.
At 5 years, 11 sufferers (0.76%) had died within the bariatric surgical procedure group vs. 10 sufferers (0.69%) within the GLP-1 group (HR = 1.316; 95% CI, 0.508-3.409). Eighty-five sufferers (5.9%) skilled main nonfatal cardiovascular occasions within the surgical procedure group vs. 83 sufferers (5.76%) within the GLP-1 group (HR = 0.812; 95percentCI, 0.599-1.1).
At 10 years, 11 sufferers (0.76%) had died within the surgical procedure group vs. 10 sufferers (0.69%) within the GLP-1 group (HR =1.316; 95percentCI, 0.508-3.409). Equally, 89 sufferers (6.18%) skilled cardiovascular occasions within the surgical procedure group vs. 85 (5.9%) within the GLP-1 group (HR = 0.806; 95% CI, 0.597-1.088).
Nonetheless, sufferers who underwent bariatric surgical procedure had considerably decrease threat for power kidney illness at 5 years (n = 46 vs. 66; 3.19% vs. 4.58%; HR = 0.569; 95% CI, 0.39-0.831) and at 10 years (n = 50 vs. 70; 3.47% vs. 4.86%; HR = 0.552; 95% CI, 0.382-0.797) in contrast with those that acquired GLP-1s.
Conversely, sufferers within the GLP-1 group had decrease threat for hypertension at 5 years (n = 799; 55.45%) than these within the surgical procedure group (n = 863; 59.89%; HR = 1.19; 95% CI, 1.08-1.311). This discovering remained constant at 10 years (HR = 1.19; 1.08-1.311).
Not one of the sufferers developed cirrhosis at both timepoint.
“Each teams had decreased mortality and cardiovascular occasions, and the GLP-1 group had very placing ends in mortality and illness development, which was superb to see,” Simons-Linares mentioned. “They’re comparable, that means that if somebody just isn’t prepared for bariatric surgical procedure or can not entry it, you would begin bettering their outcomes with these drugs.”
Simons-Linares hopes to see future research consider this topic in a potential setting with fewer sufferers.
“We wanted to make use of a big database to get the variety of sufferers we included on this examine,” Simons-Linares advised Healio. “Trying forward, we might have to do that at a smaller scale, in a randomized examine, and observe these sufferers prospectively to see whether or not they really are comparable.”
For extra info:
C. Roberto Simons–Linares, MD, will be reached at gastroenterology@healio.com.
Sources/Disclosures
Collapse
Naseem Z, et al. Outcomes in sufferers with sort 2 diabetes with MASH and MASLD: A comparability between bariatric surgical procedure and GLP-1 agonists. Offered at: Digestive Illness Week; Might 3-6, 2025; San Diego.
Disclosures:
Simons-Linares reviews no related monetary disclosures.
