Real-World Effectiveness and Safety of GLP-1 Receptor Agonists Among Patients With Weight Recurrence After Bariatric Surgery.

OBJECTIVE: This study assessed glucagon-like peptide-1 receptor agonist (GLP-1 RA) effectiveness and safety in adults with weight recurrence after metabolic and bariatric surgery (MBS). METHODS: We conducted a retrospective new-user cohort study using OneFlorida+ Data Trust (2015-2024) among adults with ≥ 10% post-MBS weight recurrence. GLP-1 RA users were matched to non-users on BMI and timing of clinical encounter; the index date was defined as GLP-1 RA initiation for users and a matched reference date for non-users. Inverse probability of treatment weighting was applied to further control for confounding. Effectiveness was measured as percentage of recurrent weight lost [(index weight - follow-up weight) ÷ (index weight - nadir weight) × 100] at 6 and 12 months; safety outcomes included gastrointestinal and post-MBS adverse events. Effectiveness was compared using t-tests, and safety was assessed using Cox proportional hazards models. RESULTS: Among patients with ≥ 10% weight recurrence, 68 GLP-1 RA users and 131 non-users were included at 6 months, and 72 users and 139 non-users were included at 12 months. GLP-1 RA users lost significantly more recurrent weight at 6 months (9.6% vs. 4.3%, p = 0.005) and 12 months (14.8% vs. 8.1%, p = 0.017), with no increased risk of adverse events at either time point. CONCLUSIONS: Among adults with post-MBS weight recurrence, GLP-1 RAs were associated with greater weight loss without increased adverse events.