Adjuvant Glucagon-like Peptide-1 Receptor Agonist Therapy Post-Bariatric Surgery: An Exploratory Single-Institution Analysis.

INTRODUCTION: Suboptimal clinical response can occur after bariatric surgery. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are becoming increasingly available for managing obesity and may augment weight loss after bariatric surgery. This exploratory study aimed to evaluate the association between adjuvant GLP-1RA use and post-bariatric surgery weight loss outcomes. METHODS: A single-institution retrospective cohort of adults who underwent sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) between July 2022 and June 2024 was identified. Patients initiated on GLP-1RA therapy (semaglutide or tirzepatide) within one year postoperatively (adjuvant GLP-1RA) were compared to those without GLP-1RA therapy (GLP-naive). Propensity-score matched outcomes, including total weight loss percentage (TWL%) and excess weight loss percentage, were compared at 2 wk and 3, 6, and 12 mo postoperatively. RESULTS: A total of 808 patients were identified. Adjuvant GLP-1RA and GLP-naive groups consisted of 22 and 385 (SG) and 7 and 394 (RYGB) patients, respectively. The mean time-to-initiation of GLP-1RA therapy was 7.8 ± 3.0 mo (SG) and 7.9 ± 2.3 mo (RYGB) postoperatively. No statistically significant difference in weight loss outcomes was observed between the adjuvant GLP-1RA or GLP-naive groups in either procedural cohort at any postoperative time point after propensity score matching on baseline characteristics and early postoperative weight loss (P ≥ 0.07). Within the SG procedural cohort, TWL% was numerically higher in the adjuvant GLP-1RA group but did not reach statistical significance (22.6% versus 18.3%, P = 0.07). CONCLUSIONS: Adjuvant GLP-1RA therapy was not associated with significantly improved weight loss outcomes after bariatric surgery, though a trend toward increased TWL% with adjuvant GLP-1RA therapy was observed for patients who underwent SG. Larger, prospective studies evaluating earlier initiation and longer duration of post-bariatric GLP-1RA therapy are needed to further characterize the potential benefit of this intervention.