Anti-Obesity Medications in 2024:
What Do I Need To Know?
Sean M. O’Neill, MD, PhD
MSQC/ASPIRE Joint Meeting
April 12, 2024
maridebart cafraglutide
vs
Oatzempic
Sean M. O’Neill, MD, PhD
MSQC/ASPIRE Joint Meeting
April 12, 2024
Disclosures
• None
Objective
• As anesthesia providers and surgeons,
what do we absolutely need to know about anti-obesity medications
(mainly, GLP-1 receptor agonists) in 2024?
Objective
• As anesthesia providers and surgeons,
what do we absolutely need to know about anti-obesity medications
(mainly, GLP-1 receptor agonists) in 2024?
• You may have to cancel cases
Objective
• As anesthesia providers and surgeons,
what do we absolutely need to know about anti-obesity medications
(mainly, GLP-1 receptor agonists) in 2024?
• You may have to cancel cases
• You may experience having your cases canceled
Objective
• As anesthesia providers and surgeons,
what do we absolutely need to know about anti-obesity medications
(mainly, GLP-1 receptor agonists) in 2024?
• You may have to cancel cases
• You may experience having your cases canceled
• This area is changing very rapidly, and will continue to do so
Outline
• Fun Facts
• Definitions
• History of AOMs
• Current Pharmacopeia
• Effectiveness
• Side Effects/Adverse Events
• Usage
• Implications for Anesthesia and Surgery
Outline
• Fun Facts (and non-fact phenomena)
• Definitions
• History of AOMs
• Current Pharmacopeia
• Effectiveness
• Side Effects/Adverse Events
• Usage
• Implications for Anesthesia and Surgery
2023
2024
>
396 B
>
Outline
• Fun Facts (and non-fact phenomena)
• Definitions
• History of AOMs
• Current Pharmacopeia
• Effectiveness
• Side Effects/Adverse Events
• Usage
• Implications for Anesthesia and Surgery
Anti-Obesity Medication (AOM)
• FDA Indication is for:
Chronic weight management as an adjunct to diet and exercise if:
• BMI > 30 kg/m^2
OR
• BMI > 27 kg/m^2 & at least 1 weight-related comorbidity
Anti-Obesity Medication (AOM)
Minimum benchmark for approval:
• Mean weight loss in treated group is >5% greater than placebo group
OR
• >5% weight loss achieved in >35% of the treated population
(and double the rate of >5% weight loss in the placebo group)
AND
• Cardiovascular safety trials
Outline
• Fun Facts (and non-fact phenomena)
• Definitions
• History of AOMs
• Current Pharmacopeia
• Effectiveness
• Side Effects/Adverse Events
• Usage
• Implications for Anesthesia and Surgery
AOM Timeline
• 1959: Phentermine, Diethylpropion
• 1960: Benzphetamine
• 1961: Phendimetrazine
• 1973: Fenfluramine (withdrawn 1998, pulmonary HTN)
• 1996: Dexfenfluramine (withdrawn 1998, pulmonary HTN)
• 1999: Orlistat
• 2012: Phentermine/Topiramate
• 2012: Lorcaserin (withdrawn 2020, increased risk of pancreatic, colon, lung CA)
• 2014: Naltrexone/Bupropion
• 2014: Liraglutide 3 mg SC
• 2021: Semaglutide 2.4 mg SC
• (TBD): Tirzepatide 5/10/15 mg SC
Mechanism
Sympathomimetic / Appetite Suppression
AOM Timeline
• 1959: Phentermine, Diethylpropion
• 1960: Benzphetamine
• 1961: Phendimetrazine
• 1973: Fenfluramine
• 1996: Dexfenfluramine
• 1999: Orlistat
• 2012: Phentermine/Topiramate
• 2012: Lorcaserin (withdrawn 2020, increased risk of pancreatic, colon, lung CA)
• 2014: Naltrexone/Bupropion
• 2014: Liraglutide 3 mg SC
• 2021: Semaglutide 2.4 mg SC
• (TBD): Tirzepatide 5/10/15 mg SC
Mechanism
Sympathomimetic / Appetite Suppression
Sympathomimetic / Appetite Suppression
AOM Timeline
• 1959: Phentermine, Diethylpropion
• 1960: Benzphetamine
• 1961: Phendimetrazine
• 1973: Fenfluramine
• 1996: Dexfenfluramine
• 1999: Orlistat
• 2012: Phentermine/Topiramate
• 2012: Lorcaserin (withdrawn 2020, increased risk of pancreatic, colon, lung CA)
• 2014: Naltrexone/Bupropion
• 2014: Liraglutide 3 mg SC
• 2021: Semaglutide 2.4 mg SC
• (TBD): Tirzepatide 5/10/15 mg SC
Mechanism
Sympathomimetic / Appetite Suppression
(withdrawn 1998, pulmonary HTN)
(withdrawn 1998, pulmonary HTN)
AOM Timeline
• 1959: Phentermine, Diethylpropion
• 1960: Benzphetamine
• 1961: Phendimetrazine
• 1973: Fenfluramine
• 1996: Dexfenfluramine
• 1999: Orlistat
• 2012: Phentermine/Topiramate
• 2012: Lorcaserin (withdrawn 2020, increased risk of pancreatic, colon, lung CA)
• 2014: Naltrexone/Bupropion
• 2014: Liraglutide 3 mg SC
• 2021: Semaglutide 2.4 mg SC
• (TBD): Tirzepatide 5/10/15 mg SC
Mechanism
Sympathomimetic / Appetite Suppression
Fat absorption (pancreatic lipase) inhibitor
AOM Timeline
• 1959: Phentermine, Diethylpropion
• 1960: Benzphetamine
• 1961: Phendimetrazine
• 1973: Fenfluramine
• 1996: Dexfenfluramine
• 1999: Orlistat
• 2012: Lorcaserin
• 2012: Phentermine/Topiramate
• 2014: Naltrexone/Bupropion
• 2014: Liraglutide 3 mg SC
• 2021: Semaglutide 2.4 mg SC
• (TBD): Tirzepatide 5/10/15 mg SC
Mechanism
Sympathomimetic / Appetite Suppression
Fat absorption (pancreatic lipase) inhibitor
Serotonin R agonist (Hypothalamic POMC cells)
AOM Timeline
• 1959: Phentermine, Diethylpropion
• 1960: Benzphetamine
• 1961: Phendimetrazine
• 1973: Fenfluramine
• 1996: Dexfenfluramine
• 1999: Orlistat
• 2012: Lorcaserin
• 2012: Phentermine/Topiramate
• 2014: Naltrexone/Bupropion
• 2014: Liraglutide 3 mg SC
• 2021: Semaglutide 2.4 mg SC
• (TBD): Tirzepatide 5/10/15 mg SC
Mechanism
Sympathomimetic / Appetite Suppression
Fat absorption (pancreatic lipase) inhibitor
(withdrawn 2020; panc, colon, lung CA risk)
AOM Timeline
• 1959: Phentermine, Diethylpropion
• 1960: Benzphetamine
• 1961: Phendimetrazine
• 1973: Fenfluramine
• 1996: Dexfenfluramine
• 1999: Orlistat
• 2012: Lorcaserin
• 2012: Phentermine/Topiramate
• 2014: Naltrexone/Bupropion
• 2014: Liraglutide 3 mg SC
• 2021: Semaglutide 2.4 mg SC
• (TBD): Tirzepatide 5/10/15 mg SC
Mechanism
Sympathomimetic
Fat absorption (pancreatic lipase) inhibitor
Sympathomimetic + Appetite Suppressant
POMC ag, Opioid antag, Dopamine reup inhib
AOM Timeline
• 1959: Phentermine, Diethylpropion
• 1960: Benzphetamine
• 1961: Phendimetrazine
• 1973: Fenfluramine
• 1996: Dexfenfluramine
• 1999: Orlistat
• 2012: Lorcaserin
• 2012: Phentermine/Topiramate
• 2014: Naltrexone/Bupropion
• 2014: Liraglutide 3 mg SC
• 2021: Semaglutide 2.4 mg SC
• (TBD): Tirzepatide 5/10/15 mg SC
Mechanism
Sympathomimetic
Fat absorption (pancreatic lipase) inhibitor
Sympathomimetic + Appetite Suppressant
POMC ag, Opioid antag, Dopamine reup inhib
Glucagon-like Peptide-1 (GLP-1) Rec Agonist
AOM Timeline
• 1959: Phentermine, Diethylpropion
• 1960: Benzphetamine
• 1961: Phendimetrazine
• 1973: Fenfluramine
• 1996: Dexfenfluramine
• 1999: Orlistat
• 2012: Lorcaserin
• 2012: Phentermine/Topiramate
• 2014: Naltrexone/Bupropion
• 2014: Liraglutide 3 mg SC
• 2021: Semaglutide 2.4 mg SC
• 2022: Tirzepatide 5/10/15 mg SC
•
Mechanism
Sympathomimetic
Fat absorption (pancreatic lipase) inhibitor
Sympathomimetic + Appetite Suppressant
POMC ag, Opioid antag, Dopamine reup inhib
Glucagon-like Peptide-1 (GLP-1) Rec Agonist
Glucagon-like Peptide-1 (GLP-1) Rec Agonist
GLP-1 Agonist + GIP Receptor Agonist
AOM Timeline
• 1959: Phentermine, Diethylpropion
• 1960: Benzphetamine
• 1961: Phendimetrazine
• 1973: Fenfluramine
• 1996: Dexfenfluramine
• 1999: Orlistat
• 2012: Lorcaserin
• 2012: Phentermine/Topiramate
• 2014: Naltrexone/Bupropion
• 2014: Liraglutide 3 mg SC
• 2021: Semaglutide 2.4 mg SC
• 2022: Tirzepatide 5/10/15 mg SC
• (TBD): maridebart cafraglutide TBD mg SC
Mechanism
Sympathomimetic
Fat absorption (pancreatic lipase) inhibitor
Sympathomimetic + Appetite Suppressant
POMC ag, Opioid antag, Dopamine reup inhib
Glucagon-like Peptide-1 (GLP-1) Rec Agonist
Glucagon-like Peptide-1 (GLP-1) Rec Agonist
GLP-1 Agonist + GIP Receptor Agonist
GLP-1 Agonist + GIP Receptor Antagonist
Outline
• Fun Facts (and non-fact phenomena)
• Definitions
• History of AOMs
• Current Pharmacopeia
• Mechanism/Dosing
• Effectiveness
• Side Effects/Adverse Events
• Usage
• Implications for Anesthesia and Surgery
AOMs: Current Pharmacopeia
• 1959: Phentermine, Diethylpropion
• 1960: Benzphetamine
• 1961: Phendimetrazine
• 1999: Orlistat
• 2012: Phentermine/Topiramate
• 2014: Naltrexone/Bupropion
• 2014: Liraglutide 3 mg SC
• 2021: Semaglutide 2.4 mg SC
• 2022: Tirzepatide 5/10/15 mg SC
Mechanism
Sympathomimetic
Pancreatic lipase inhibitor
Sympathomimetic + Appetite Supp
POMC ag, Opioid antag, Dopamine
GLP-1 RA
GLP-1 + GIP RA
GLP-1 RA
AOMs: Current Pharmacopeia
• 1959: Phentermine, Diethylpropion
• 1960: Benzphetamine
• 1961: Phendimetrazine
• 1999: Orlistat
• 2012: Phentermine/Topiramate
• 2014: Naltrexone/Bupropion
• 2014: Liraglutide 3 mg SC
• 2021: Semaglutide 2.4 mg SC
• 2022: Tirzepatide 5/10/15 mg SC
Trade Name
Adipex-P, Tenuate
Didrex
Bontrex, Adipost, Anorex, …
Xenical
Qsymia
Contrave
Saxenda
Zepbound / Mounjaro
Wegovy
AOMs: Current Pharmacopeia
• 1959: Phentermine, Diethylpropion
• 1960: Benzphetamine
• 1961: Phendimetrazine
• 1999: Orlistat
• 2012: Phentermine/Topiramate
• 2014: Naltrexone/Bupropion
• 2014: Liraglutide 3 mg SC
• 2021: Semaglutide 2.4 mg SC
• 2022: Tirzepatide 5/10/15 mg SC
Mechanism
Sympathomimetic
Pancreatic lipase inhibitor
Sympathomimetic + Appetite Supp
POMC ag, Opioid antag, Dopamine
GLP-1 RA
GLP-1 + GIP RA
GLP-1 RA
GLP-1 RAs
• Liraglutide
• Semaglutide
• Tirzepatide
GLP-1 RA
Drucker DJ. Mechanisms of Action and Therapeutic Application of Glucagon-like Peptide-1.
Cell Metab. 2018 Apr 3;27(4):740-756.
GLP-1 RAs for T2DM (but also Obesity)
• Liraglutide 3 mg SC daily
• T2DM indication: liraglutide 1.2/1.8 mg SC daily (2010)
• Semaglutide 2.4 mg SC weekly
• T2DM indication: semaglutide 0.5/1/2 mg SC weekly (2017)
• T2DM indication: semaglutide 3/7/14 mg PO daily (2019)
• Tirzepatide 5/10/15 mg SC weekly*
• T2DM indication: tirzepatide 5/10/15 mg SC weekly (2022)
GLP-1 RAs for T2DM (but also Obesity)
• Liraglutide 3 mg SC daily Saxenda
• T2DM indication: liraglutide 1.2/1.8 mg SC daily (2010) Victoza
• Semaglutide 2.4 mg SC weekly Wegovy
• T2DM indication: semaglutide 0.5/1/2 mg SC weekly (2017) Ozempic
• T2DM indication: semaglutide 3/7/14 mg PO daily (2019) Rybelsus
• Tirzepatide 5/10/15 mg SC weekly* Zepbound
• T2DM indication: tirzepatide 5/10/15 mg SC weekly (2022) Mounjaro
Trade Name
Outline
• Fun Facts (and non-fact phenomena)
• Definitions
• History of AOMs
• Current Pharmacopeia
• Mechanism/Dosing
• Effectiveness
• Side Effects/Adverse Events
• Usage
• Implications for Anesthesia and Surgery
Total Body Weight Loss %
1. Khera R, Murad MH, Chandar AK, Dulai PS, Wang Z, Prokop LJ, Loomba R, Camilleri M, Singh S. Association of Pharmacological Treatments for Obesity With Weight Loss and Adverse Events: A Systematic Review and Meta-analysis. JAMA. 2016 Jun 14;315(22):2424-34.
2. Rubino DM, Greenway FL, Khalid U, O'Neil PM, Rosenstock J, Sørrig R, Wadden TA, Wizert A, Garvey WT; STEP 8 Investigators. Effect of Weekly Subcutaneous Semaglutide vs Daily Liraglutide on Body Weight in Adults With Overweight or Obesity Without Diabetes: The STEP 8
Randomized Clinical Trial. JAMA. 2022 Jan 11;327(2):138-150.
3. Wilding JPH, Batterham RL, Calanna S, Davies M, Van Gaal LF, Lingvay I, McGowan BM, Rosenstock J, Tran MTD, Wadden TA, Wharton S, Yokote K, Zeuthen N, Kushner RF; STEP 1 Study Group. Once-Weekly Semaglutide in Adults with Overweight or Obesity. N Engl J Med. 2021 Mar
18;384(11):989-1002.
4. Jastreboff AM, Aronne LJ, Ahmad NN, Wharton S, Connery L, Alves B, Kiyosue A, Zhang S, Liu B, Bunck MC, Stefanski A; SURMOUNT-1 Investigators. Tirzepatide Once Weekly for the Treatment of Obesity. N Engl J Med. 2022 Jul 21;387(3):205-216.
5. Yanovski SZ, Yanovski JA. Long-term drug treatment for obesity: a systematic and clinical review. JAMA. 2014 Jan 1;311(1):74-86. doi: 10.1001/jama.2013.281361. PMID: 24231879; PMCID: PMC3928674.
-35%
-30%
-25%
-20%
-15%
-10%
-5%
0%
- ~3.5 kg
- 3.3%
- 5.4%
- 10%
- 6.4%
- 14.9%
- 15.0%
- 19.6%
- 20.9%
- 29.5%
- 31.9%
Total Body Weight Loss %
1. Khera R, Murad MH, Chandar AK, Dulai PS, Wang Z, Prokop LJ, Loomba R, Camilleri M, Singh S. Association of Pharmacological Treatments for Obesity With Weight Loss and Adverse Events: A Systematic Review and Meta-analysis. JAMA. 2016 Jun 14;315(22):2424-34.
2. Rubino DM, Greenway FL, Khalid U, O'Neil PM, Rosenstock J, Sørrig R, Wadden TA, Wizert A, Garvey WT; STEP 8 Investigators. Effect of Weekly Subcutaneous Semaglutide vs Daily Liraglutide on Body Weight in Adults With Overweight or Obesity Without Diabetes: The STEP 8
Randomized Clinical Trial. JAMA. 2022 Jan 11;327(2):138-150.
3. Wilding JPH, Batterham RL, Calanna S, Davies M, Van Gaal LF, Lingvay I, McGowan BM, Rosenstock J, Tran MTD, Wadden TA, Wharton S, Yokote K, Zeuthen N, Kushner RF; STEP 1 Study Group. Once-Weekly Semaglutide in Adults with Overweight or Obesity. N Engl J Med. 2021 Mar
18;384(11):989-1002.
4. Jastreboff AM, Aronne LJ, Ahmad NN, Wharton S, Connery L, Alves B, Kiyosue A, Zhang S, Liu B, Bunck MC, Stefanski A; SURMOUNT-1 Investigators. Tirzepatide Once Weekly for the Treatment of Obesity. N Engl J Med. 2022 Jul 21;387(3):205-216.
5. Yanovski SZ, Yanovski JA. Long-term drug treatment for obesity: a systematic and clinical review. JAMA. 2014 Jan 1;311(1):74-86. doi: 10.1001/jama.2013.281361. PMID: 24231879; PMCID: PMC3928674.
-35%
-30%
-25%
-20%
-15%
-10%
-5%
0%
- ~3.5 kg
- 3.3%
- 5.4%
- 10%
- 6.4%
- 14.9%
- 15.0%
- 19.6%
- 20.9%
- 29.5%
- 31.9%
Total Body Weight Loss %
1. Khera R, Murad MH, Chandar AK, Dulai PS, Wang Z, Prokop LJ, Loomba R, Camilleri M, Singh S. Association of Pharmacological Treatments for Obesity With Weight Loss and Adverse Events: A Systematic Review and Meta-analysis. JAMA. 2016 Jun 14;315(22):2424-34.
2. Rubino DM, Greenway FL, Khalid U, O'Neil PM, Rosenstock J, Sørrig R, Wadden TA, Wizert A, Garvey WT; STEP 8 Investigators. Effect of Weekly Subcutaneous Semaglutide vs Daily Liraglutide on Body Weight in Adults With Overweight or Obesity Without Diabetes: The STEP 8
Randomized Clinical Trial. JAMA. 2022 Jan 11;327(2):138-150.
3. Wilding JPH, Batterham RL, Calanna S, Davies M, Van Gaal LF, Lingvay I, McGowan BM, Rosenstock J, Tran MTD, Wadden TA, Wharton S, Yokote K, Zeuthen N, Kushner RF; STEP 1 Study Group. Once-Weekly Semaglutide in Adults with Overweight or Obesity. N Engl J Med. 2021 Mar
18;384(11):989-1002.
4. Jastreboff AM, Aronne LJ, Ahmad NN, Wharton S, Connery L, Alves B, Kiyosue A, Zhang S, Liu B, Bunck MC, Stefanski A; SURMOUNT-1 Investigators. Tirzepatide Once Weekly for the Treatment of Obesity. N Engl J Med. 2022 Jul 21;387(3):205-216.
5. Yanovski SZ, Yanovski JA. Long-term drug treatment for obesity: a systematic and clinical review. JAMA. 2014 Jan 1;311(1):74-86. doi: 10.1001/jama.2013.281361. PMID: 24231879; PMCID: PMC3928674.
-35%
-30%
-25%
-20%
-15%
-10%
-5%
0%
- ~3.5 kg
- 3.3%
- 5.4%
- 10%
- 6.4%
- 14.9%
- 15.0%
- 19.6%
- 20.9%
- 31.9%
Total Body Weight Loss %
1. Khera R, Murad MH, Chandar AK, Dulai PS, Wang Z, Prokop LJ, Loomba R, Camilleri M, Singh S. Association of Pharmacological Treatments for Obesity With Weight Loss and Adverse Events: A Systematic Review and Meta-analysis. JAMA. 2016 Jun 14;315(22):2424-34.
2. Rubino DM, Greenway FL, Khalid U, O'Neil PM, Rosenstock J, Sørrig R, Wadden TA, Wizert A, Garvey WT; STEP 8 Investigators. Effect of Weekly Subcutaneous Semaglutide vs Daily Liraglutide on Body Weight in Adults With Overweight or Obesity Without Diabetes: The STEP 8
Randomized Clinical Trial. JAMA. 2022 Jan 11;327(2):138-150.
3. Wilding JPH, Batterham RL, Calanna S, Davies M, Van Gaal LF, Lingvay I, McGowan BM, Rosenstock J, Tran MTD, Wadden TA, Wharton S, Yokote K, Zeuthen N, Kushner RF; STEP 1 Study Group. Once-Weekly Semaglutide in Adults with Overweight or Obesity. N Engl J Med. 2021 Mar
18;384(11):989-1002.
4. Jastreboff AM, Aronne LJ, Ahmad NN, Wharton S, Connery L, Alves B, Kiyosue A, Zhang S, Liu B, Bunck MC, Stefanski A; SURMOUNT-1 Investigators. Tirzepatide Once Weekly for the Treatment of Obesity. N Engl J Med. 2022 Jul 21;387(3):205-216.
5. Yanovski SZ, Yanovski JA. Long-term drug treatment for obesity: a systematic and clinical review. JAMA. 2014 Jan 1;311(1):74-86. doi: 10.1001/jama.2013.281361. PMID: 24231879; PMCID: PMC3928674.
-35%
-30%
-25%
-20%
-15%
-10%
-5%
0%
- ~3.5 kg
- 3.3%
- 10%
- 6.4%
- 14.9%
- 15.0%
- 19.6%
- 20.9%
- 31.9%
Total Body Weight Loss %
1. Khera R, Murad MH, Chandar AK, Dulai PS, Wang Z, Prokop LJ, Loomba R, Camilleri M, Singh S. Association of Pharmacological Treatments for Obesity With Weight Loss and Adverse Events: A Systematic Review and Meta-analysis. JAMA. 2016 Jun 14;315(22):2424-34.
2. Rubino DM, Greenway FL, Khalid U, O'Neil PM, Rosenstock J, Sørrig R, Wadden TA, Wizert A, Garvey WT; STEP 8 Investigators. Effect of Weekly Subcutaneous Semaglutide vs Daily Liraglutide on Body Weight in Adults With Overweight or Obesity Without Diabetes: The STEP 8
Randomized Clinical Trial. JAMA. 2022 Jan 11;327(2):138-150.
3. Wilding JPH, Batterham RL, Calanna S, Davies M, Van Gaal LF, Lingvay I, McGowan BM, Rosenstock J, Tran MTD, Wadden TA, Wharton S, Yokote K, Zeuthen N, Kushner RF; STEP 1 Study Group. Once-Weekly Semaglutide in Adults with Overweight or Obesity. N Engl J Med. 2021 Mar
18;384(11):989-1002.
4. Jastreboff AM, Aronne LJ, Ahmad NN, Wharton S, Connery L, Alves B, Kiyosue A, Zhang S, Liu B, Bunck MC, Stefanski A; SURMOUNT-1 Investigators. Tirzepatide Once Weekly for the Treatment of Obesity. N Engl J Med. 2022 Jul 21;387(3):205-216.
5. Yanovski SZ, Yanovski JA. Long-term drug treatment for obesity: a systematic and clinical review. JAMA. 2014 Jan 1;311(1):74-86. doi: 10.1001/jama.2013.281361. PMID: 24231879; PMCID: PMC3928674.
-35%
-30%
-25%
-20%
-15%
-10%
-5%
0%
- ~3.5 kg
- 3.3%
- 5.4%
- 10%
- 6.4%
- 14.9%
- 15.0%
- 19.6%
- 20.9%
- 31.9%
Total Body Weight Loss %
1. Khera R, Murad MH, Chandar AK, Dulai PS, Wang Z, Prokop LJ, Loomba R, Camilleri M, Singh S. Association of Pharmacological Treatments for Obesity With Weight Loss and Adverse Events: A Systematic Review and Meta-analysis. JAMA. 2016 Jun 14;315(22):2424-34.
2. Rubino DM, Greenway FL, Khalid U, O'Neil PM, Rosenstock J, Sørrig R, Wadden TA, Wizert A, Garvey WT; STEP 8 Investigators. Effect of Weekly Subcutaneous Semaglutide vs Daily Liraglutide on Body Weight in Adults With Overweight or Obesity Without Diabetes: The STEP 8
Randomized Clinical Trial. JAMA. 2022 Jan 11;327(2):138-150.
3. Wilding JPH, Batterham RL, Calanna S, Davies M, Van Gaal LF, Lingvay I, McGowan BM, Rosenstock J, Tran MTD, Wadden TA, Wharton S, Yokote K, Zeuthen N, Kushner RF; STEP 1 Study Group. Once-Weekly Semaglutide in Adults with Overweight or Obesity. N Engl J Med. 2021 Mar
18;384(11):989-1002.
4. Jastreboff AM, Aronne LJ, Ahmad NN, Wharton S, Connery L, Alves B, Kiyosue A, Zhang S, Liu B, Bunck MC, Stefanski A; SURMOUNT-1 Investigators. Tirzepatide Once Weekly for the Treatment of Obesity. N Engl J Med. 2022 Jul 21;387(3):205-216.
5. Yanovski SZ, Yanovski JA. Long-term drug treatment for obesity: a systematic and clinical review. JAMA. 2014 Jan 1;311(1):74-86. doi: 10.1001/jama.2013.281361. PMID: 24231879; PMCID: PMC3928674.
-35%
-30%
-25%
-20%
-15%
-10%
-5%
0%
- ~3.5 kg
- 3.3%
- 5.4%
- 10%
- 6.4%
- 14.9%
- 15.0%
- 19.6%
- 29.5%
- 31.9%
Total Body Weight Loss %
1. Khera R, Murad MH, Chandar AK, Dulai PS, Wang Z, Prokop LJ, Loomba R, Camilleri M, Singh S. Association of Pharmacological Treatments for Obesity With Weight Loss and Adverse Events: A Systematic Review and Meta-analysis. JAMA. 2016 Jun 14;315(22):2424-34.
2. Rubino DM, Greenway FL, Khalid U, O'Neil PM, Rosenstock J, Sørrig R, Wadden TA, Wizert A, Garvey WT; STEP 8 Investigators. Effect of Weekly Subcutaneous Semaglutide vs Daily Liraglutide on Body Weight in Adults With Overweight or Obesity Without Diabetes: The STEP 8
Randomized Clinical Trial. JAMA. 2022 Jan 11;327(2):138-150.
3. Wilding JPH, Batterham RL, Calanna S, Davies M, Van Gaal LF, Lingvay I, McGowan BM, Rosenstock J, Tran MTD, Wadden TA, Wharton S, Yokote K, Zeuthen N, Kushner RF; STEP 1 Study Group. Once-Weekly Semaglutide in Adults with Overweight or Obesity. N Engl J Med. 2021 Mar
18;384(11):989-1002.
4. Jastreboff AM, Aronne LJ, Ahmad NN, Wharton S, Connery L, Alves B, Kiyosue A, Zhang S, Liu B, Bunck MC, Stefanski A; SURMOUNT-1 Investigators. Tirzepatide Once Weekly for the Treatment of Obesity. N Engl J Med. 2022 Jul 21;387(3):205-216.
5. Yanovski SZ, Yanovski JA. Long-term drug treatment for obesity: a systematic and clinical review. JAMA. 2014 Jan 1;311(1):74-86. doi: 10.1001/jama.2013.281361. PMID: 24231879; PMCID: PMC3928674.
-35%
-30%
-25%
-20%
-15%
-10%
-5%
0%
- ~3.5 kg
- 3.3%
- 5.4%
- 10%
- 6.4%
- 15.0%
- 19.6%
- 29.5%
- 31.9%
Total Body Weight Loss %
1. Khera R, Murad MH, Chandar AK, Dulai PS, Wang Z, Prokop LJ, Loomba R, Camilleri M, Singh S. Association of Pharmacological Treatments for Obesity With Weight Loss and Adverse Events: A Systematic Review and Meta-analysis. JAMA. 2016 Jun 14;315(22):2424-34.
2. Rubino DM, Greenway FL, Khalid U, O'Neil PM, Rosenstock J, Sørrig R, Wadden TA, Wizert A, Garvey WT; STEP 8 Investigators. Effect of Weekly Subcutaneous Semaglutide vs Daily Liraglutide on Body Weight in Adults With Overweight or Obesity Without Diabetes: The STEP 8
Randomized Clinical Trial. JAMA. 2022 Jan 11;327(2):138-150.
3. Wilding JPH, Batterham RL, Calanna S, Davies M, Van Gaal LF, Lingvay I, McGowan BM, Rosenstock J, Tran MTD, Wadden TA, Wharton S, Yokote K, Zeuthen N, Kushner RF; STEP 1 Study Group. Once-Weekly Semaglutide in Adults with Overweight or Obesity. N Engl J Med. 2021 Mar
18;384(11):989-1002.
4. Jastreboff AM, Aronne LJ, Ahmad NN, Wharton S, Connery L, Alves B, Kiyosue A, Zhang S, Liu B, Bunck MC, Stefanski A; SURMOUNT-1 Investigators. Tirzepatide Once Weekly for the Treatment of Obesity. N Engl J Med. 2022 Jul 21;387(3):205-216.
5. Yanovski SZ, Yanovski JA. Long-term drug treatment for obesity: a systematic and clinical review. JAMA. 2014 Jan 1;311(1):74-86. doi: 10.1001/jama.2013.281361. PMID: 24231879; PMCID: PMC3928674.
-35%
-30%
-25%
-20%
-15%
-10%
-5%
0%
- ~3.5 kg
- 3.3%
- 5.4%
- 10%
- 6.4%
- 14.9%
- 15.0%
- 19.6%
- 29.5%
- 31.9%
Total Body Weight Loss %
1. Khera R, Murad MH, Chandar AK, Dulai PS, Wang Z, Prokop LJ, Loomba R, Camilleri M, Singh S. Association of Pharmacological Treatments for Obesity With Weight Loss and Adverse Events: A Systematic Review and Meta-analysis. JAMA. 2016 Jun 14;315(22):2424-34.
2. Rubino DM, Greenway FL, Khalid U, O'Neil PM, Rosenstock J, Sørrig R, Wadden TA, Wizert A, Garvey WT; STEP 8 Investigators. Effect of Weekly Subcutaneous Semaglutide vs Daily Liraglutide on Body Weight in Adults With Overweight or Obesity Without Diabetes: The STEP 8
Randomized Clinical Trial. JAMA. 2022 Jan 11;327(2):138-150.
3. Wilding JPH, Batterham RL, Calanna S, Davies M, Van Gaal LF, Lingvay I, McGowan BM, Rosenstock J, Tran MTD, Wadden TA, Wharton S, Yokote K, Zeuthen N, Kushner RF; STEP 1 Study Group. Once-Weekly Semaglutide in Adults with Overweight or Obesity. N Engl J Med. 2021 Mar
18;384(11):989-1002.
4. Jastreboff AM, Aronne LJ, Ahmad NN, Wharton S, Connery L, Alves B, Kiyosue A, Zhang S, Liu B, Bunck MC, Stefanski A; SURMOUNT-1 Investigators. Tirzepatide Once Weekly for the Treatment of Obesity. N Engl J Med. 2022 Jul 21;387(3):205-216.
5. Yanovski SZ, Yanovski JA. Long-term drug treatment for obesity: a systematic and clinical review. JAMA. 2014 Jan 1;311(1):74-86. doi: 10.1001/jama.2013.281361. PMID: 24231879; PMCID: PMC3928674.
-35%
-30%
-25%
-20%
-15%
-10%
-5%
0%
- ~3.5 kg
- 3.3%
- 5.4%
- 10%
- 6.4%
- 14.9%
- 15.0%
- 29.5%
- 31.9%
Total Body Weight Loss %
1. Khera R, Murad MH, Chandar AK, Dulai PS, Wang Z, Prokop LJ, Loomba R, Camilleri M, Singh S. Association of Pharmacological Treatments for Obesity With Weight Loss and Adverse Events: A Systematic Review and Meta-analysis. JAMA. 2016 Jun 14;315(22):2424-34.
2. Rubino DM, Greenway FL, Khalid U, O'Neil PM, Rosenstock J, Sørrig R, Wadden TA, Wizert A, Garvey WT; STEP 8 Investigators. Effect of Weekly Subcutaneous Semaglutide vs Daily Liraglutide on Body Weight in Adults With Overweight or Obesity Without Diabetes: The STEP 8
Randomized Clinical Trial. JAMA. 2022 Jan 11;327(2):138-150.
3. Wilding JPH, Batterham RL, Calanna S, Davies M, Van Gaal LF, Lingvay I, McGowan BM, Rosenstock J, Tran MTD, Wadden TA, Wharton S, Yokote K, Zeuthen N, Kushner RF; STEP 1 Study Group. Once-Weekly Semaglutide in Adults with Overweight or Obesity. N Engl J Med. 2021 Mar
18;384(11):989-1002.
4. Jastreboff AM, Aronne LJ, Ahmad NN, Wharton S, Connery L, Alves B, Kiyosue A, Zhang S, Liu B, Bunck MC, Stefanski A; SURMOUNT-1 Investigators. Tirzepatide Once Weekly for the Treatment of Obesity. N Engl J Med. 2022 Jul 21;387(3):205-216.
5. Yanovski SZ, Yanovski JA. Long-term drug treatment for obesity: a systematic and clinical review. JAMA. 2014 Jan 1;311(1):74-86. doi: 10.1001/jama.2013.281361. PMID: 24231879; PMCID: PMC3928674.
-35%
-30%
-25%
-20%
-15%
-10%
-5%
0%
- ~3.5 kg
- 3.3%
- 5.4%
- 10%
- 6.4%
- 14.9%
- 15.0%
- 29.5%
- 31.9%
- 19.6%
Total Body Weight Loss %
1. Khera R, Murad MH, Chandar AK, Dulai PS, Wang Z, Prokop LJ, Loomba R, Camilleri M, Singh S. Association of Pharmacological Treatments for Obesity With Weight Loss and Adverse Events: A Systematic Review and Meta-analysis. JAMA. 2016 Jun 14;315(22):2424-34.
2. Rubino DM, Greenway FL, Khalid U, O'Neil PM, Rosenstock J, Sørrig R, Wadden TA, Wizert A, Garvey WT; STEP 8 Investigators. Effect of Weekly Subcutaneous Semaglutide vs Daily Liraglutide on Body Weight in Adults With Overweight or Obesity Without Diabetes: The STEP 8
Randomized Clinical Trial. JAMA. 2022 Jan 11;327(2):138-150.
3. Wilding JPH, Batterham RL, Calanna S, Davies M, Van Gaal LF, Lingvay I, McGowan BM, Rosenstock J, Tran MTD, Wadden TA, Wharton S, Yokote K, Zeuthen N, Kushner RF; STEP 1 Study Group. Once-Weekly Semaglutide in Adults with Overweight or Obesity. N Engl J Med. 2021 Mar
18;384(11):989-1002.
4. Jastreboff AM, Aronne LJ, Ahmad NN, Wharton S, Connery L, Alves B, Kiyosue A, Zhang S, Liu B, Bunck MC, Stefanski A; SURMOUNT-1 Investigators. Tirzepatide Once Weekly for the Treatment of Obesity. N Engl J Med. 2022 Jul 21;387(3):205-216.
5. Yanovski SZ, Yanovski JA. Long-term drug treatment for obesity: a systematic and clinical review. JAMA. 2014 Jan 1;311(1):74-86. doi: 10.1001/jama.2013.281361. PMID: 24231879; PMCID: PMC3928674.
-35%
-30%
-25%
-20%
-15%
-10%
-5%
0%
- ~3.5 kg
- 3.3%
- 5.4%
- 10%
- 6.4%
- 14.9%
- 15.0%
- 19.6%
- 20.9%
- 29.5%
- 31.9%
Outline
• Fun Facts (and non-fact phenomena)
• Definitions
• History of AOMs
• Current Pharmacopeia
• Mechanism/Dosing
• Effectiveness
• Side Effects/Adverse Events
• Usage
• Implications for Anesthesia and Surgery
Adverse Effects
• Short term (< 12 weeks)
• Benzphetamine
• Diethylpropion
• Phentermine
• Phendimetrazine
• Long term
• Orlistat
• Phentermine/topiramate
• Naltrexone/bupropion
• Liraglutide
• Semaglutide
• Tirzepatide
• Insomnia, irritability, anxiety, tachycardia, tremor,
headache, diarrhea
Adverse Effects
• Short term (< 12 weeks)
• Benzphetamine
• Diethylpropion
• Phentermine
• Phendimetrazine
• Long term
• Orlistat
• Phentermine/topiramate
• Naltrexone/bupropion
• Liraglutide
• Semaglutide
• Tirzepatide
• Insomnia, irritability, anxiety, tachycardia, tremor,
headache, diarrhea
• Oily spotting (27%), Flatus/discharge(24%), Fecal urgency (22%)
Adverse Effects
• Short term (< 12 weeks)
• Benzphetamine
• Diethylpropion
• Phentermine
• Phendimetrazine
• Long term
• Orlistat
• Phentermine/topiramate
• Naltrexone/bupropion
• Liraglutide
• Semaglutide
• Tirzepatide
• Insomnia, irritability, anxiety, tachycardia, tremor,
headache, diarrhea
• Oily spotting (27%), Flatus/discharge(24%), Fecal urgency (22%)
• Constipation (15%), paresthesias (14%), dry mouth (14%)
Adverse Effects
• Short term (< 12 weeks)
• Benzphetamine
• Diethylpropion
• Phentermine
• Phendimetrazine
• Long term
• Orlistat
• Phentermine/topiramate
• Naltrexone/bupropion
• Liraglutide
• Semaglutide
• Tirzepatide
• Insomnia, irritability, anxiety, tachycardia, tremor,
headache, diarrhea
• Oily spotting (27%), Flatus/discharge(24%), Fecal urgency (22%)
• Constipation (15%), paresthesias (14%), dry mouth (14%)
• Diarrhea (7%), anxiety (4%), fatigue (4%), tremor (4%)
Adverse Effects
• Short term (< 12 weeks)
• Benzphetamine
• Diethylpropion
• Phentermine
• Phendimetrazine
• Long term
• Orlistat
• Phentermine/topiramate
• Naltrexone/bupropion
• Liraglutide
• Semaglutide
• Tirzepatide
• Insomnia, irritability, anxiety, tachycardia, tremor,
headache, diarrhea
• Oily spotting (27%), Flatus/discharge(24%), Fecal urgency (22%)
• Constipation (15%), paresthesias (14%), dry mouth (14%)
• Diarrhea (7%), anxiety (4%), fatigue (4%), tremor (4%)
• Nausea (42%), Vomiting (34%), Diarrhea (22%), Low BG (15%)
Adverse Effects
• Short term (< 12 weeks)
• Benzphetamine
• Diethylpropion
• Phentermine
• Phendimetrazine
• Long term
• Orlistat
• Phentermine/topiramate
• Naltrexone/bupropion
• Liraglutide
• Semaglutide
• Tirzepatide
• Insomnia, irritability, anxiety, tachycardia, tremor,
headache, diarrhea
• Oily spotting (27%), Flatus/discharge(24%), Fecal urgency (22%)
• Constipation (15%), paresthesias (14%), dry mouth (14%)
• Diarrhea (7%), anxiety (4%), fatigue (4%), tremor (4%)
• Nausea (42%), Vomiting (34%), Diarrhea (22%), Low BG (15%)
• Nausea (44%), Diarrhea (30%), Vomiting (24%), Low BG (6%)
Adverse Effects
• Short term (< 12 weeks)
• Benzphetamine
• Diethylpropion
• Phentermine
• Phendimetrazine
• Long term
• Orlistat
• Phentermine/topiramate
• Naltrexone/bupropion
• Liraglutide
• Semaglutide
• Tirzepatide
• Insomnia, irritability, anxiety, tachycardia, tremor,
headache, diarrhea
• Oily spotting (27%), Flatus/discharge(24%), Fecal urgency (22%)
• Constipation (15%), paresthesias (14%), dry mouth (14%)
• Diarrhea (7%), anxiety (4%), fatigue (4%), tremor (4%)
• Nausea (42%), Vomiting (34%), Diarrhea (22%), Low BG (15%)
• Nausea (44%), Diarrhea (30%), Vomiting (24%), Low BG (6%)
• Nausea (31%), Diarrhea (23%), Vomiting (12%), Low BG (2%)
Outline
• Fun Facts (and non-fact phenomena)
• Definitions
• History of AOMs
• Current Pharmacopeia
• Mechanism/Dosing
• Effectiveness
• Side Effects/Adverse Events
• Usage
• Implications for Anesthesia and Surgery
Historical Use – Boom or Bust
• 1996: 8,500 per 100,000
• 2011: 2,500 per 100,000 (2.74 M total)
• 2012-2016: 283 per 100,000 (<1M total)
• Phentermine historically dominant
(89% in 2011)
• Patients trying to lose weight:
3% reported use of an AOM
• Ineffective Weight Loss (IWL) or
Weight Regain (WR)
after Bariatric Surgery
• Use after RYGB and LAGB can
produce additional 5% TBWL
1. Yanovski SZ, Yanovski JA. Long-term drug treatment for obesity: a systematic and clinical review. JAMA. 2014 Jan 1;311(1):74-86.
2. Hampp C, Kang EM, Borders-Hemphill V. Use of prescription antiobesity drugs in the United States. Pharmacotherapy. 2013 Dec;33(12):1299-307.
3. Nor Hanipah Z, Nasr EC, Bucak E, Schauer PR, Aminian A, Brethauer SA, Cetin D. Efficacy of adjuvant weight loss medication after bariatric surgery. Surg Obes Relat Dis. 2018 Jan;14(1):93-98.
Historical Use – Out of Pocket $$
• Payment most often out of
pocket
• Insurance coverage
inconsistent
1. Yanovski SZ, Yanovski JA. Long-term drug treatment for obesity: a systematic and clinical review. JAMA. 2014 Jan 1;311(1):74-86.
2. Hampp C, Kang EM, Borders-Hemphill V. Use of prescription antiobesity drugs in the United States. Pharmacotherapy. 2013 Dec;33(12):1299-307.
3. Nor Hanipah Z, Nasr EC, Bucak E, Schauer PR, Aminian A, Brethauer SA, Cetin D. Efficacy of adjuvant weight loss medication after bariatric surgery. Surg Obes Relat Dis. 2018 Jan;14(1):93-98.
Future Projections (as of 2023)
• > 70 Million Americans with Obesity
• Previous peak AOM use: 1996
• Fen-Phen Fad, 8,500 rx/100,000 people
• 8,500 per 100,000 x 71M Obese = >6M prescriptions
1. Yanovski SZ, Yanovski JA. Long-term drug treatment for obesity: a systematic and clinical review. JAMA. 2014 Jan 1;311(1):74-86.
2. Hampp C, Kang EM, Borders-Hemphill V. Use of prescription antiobesity drugs in the United States. Pharmacotherapy. 2013 Dec;33(12):1299-307.
3. Nor Hanipah Z, Nasr EC, Bucak E, Schauer PR, Aminian A, Brethauer SA, Cetin D. Efficacy of adjuvant weight loss medication after bariatric surgery. Surg Obes Relat Dis. 2018 Jan;14(1):93-98.
Future Projections (as of 2024)
• 93 Million Americans meet criteria for a GLP-1
• 74 Million Americans BMI > 30
• Market Forecast: 20M Prescriptions/yr by 2030
• This is not investment advice
• PBM Forecast: Absolutely not
• 1% usage will increase total insurance spend by 5%
List Prices
• Short term weekly yearly
• Benzphetamine
• Diethylpropion
• Phentermine
• Phendimetrazine
• Long term
• Orlistat (OTC)
• Phentermine/topiramate
• Naltrexone/bupropion
• Liraglutide
• Semaglutide
• (Tirzepatide)
• $30 $1,560
• $27 $1,404
• $25 $1,300
• $23 $1,170
List Prices
• Short term weekly yearly
• Benzphetamine
• Diethylpropion
• Phentermine
• Phendimetrazine
• Long term
• Orlistat (OTC)
• Phentermine/topiramate
• Naltrexone/bupropion
• Liraglutide
• Semaglutide
• (Tirzepatide)
• $30 $1,560
• $27 $1,404
• $25 $1,300
• $23 $1,170
• $54 $2,808
List Prices
• Short term weekly yearly
• Benzphetamine
• Diethylpropion
• Phentermine
• Phendimetrazine
• Long term
• Orlistat (OTC)
• Phentermine/topiramate
• Naltrexone/bupropion
• Liraglutide
• Semaglutide
• (Tirzepatide)
• $30 $1,560
• $27 $1,404
• $25 $1,300
• $23 $1,170
• $54 $2,808
• $50 $2,600
List Prices
• Short term weekly yearly
• Benzphetamine
• Diethylpropion
• Phentermine
• Phendimetrazine
• Long term
• Orlistat (OTC)
• Phentermine/topiramate
• Naltrexone/bupropion
• Liraglutide
• Semaglutide
• (Tirzepatide)
• $30 $1,560
• $27 $1,404
• $25 $1,300
• $23 $1,170
• $54 $2,808
• $50 $2,600
• $165 $8,580
List Prices
• Short term weekly yearly
• Benzphetamine
• Diethylpropion
• Phentermine
• Phendimetrazine
• Long term
• Orlistat (OTC)
• Phentermine/topiramate
• Naltrexone/bupropion
• Liraglutide
• Semaglutide
• (Tirzepatide)
• $30 $1,560
• $27 $1,404
• $25 $1,300
• $23 $1,170
• $54 $2,808
• $50 $2,600
• $165 $8,580
• $315 $16,368
List Prices
• Short term weekly yearly
• Benzphetamine
• Diethylpropion
• Phentermine
• Phendimetrazine
• Long term
• Orlistat (OTC)
• Phentermine/topiramate
• Naltrexone/bupropion
• Liraglutide
• Semaglutide
• (Tirzepatide)
• $30 $1,560
• $27 $1,404
• $25 $1,300
• $23 $1,170
• $54 $2,808
• $50 $2,600
• $165 $8,580
• $315 $16,368
• $1,349 $70,148
List Prices
• Short term weekly yearly
• Benzphetamine
• Diethylpropion
• Phentermine
• Phendimetrazine
• Long term
• Orlistat (OTC)
• Phentermine/topiramate
• Naltrexone/bupropion
• Liraglutide
• Semaglutide
• Tirzepatide
• $30 $1,560
• $27 $1,404
• $25 $1,300
• $23 $1,170
• $54 $2,808
• $50 $2,600
• $165 $8,580
• $315 $16,368
• $1,349 $70,148
• $1,023 $53,198
List Prices
• Short term weekly yearly
• Benzphetamine
• Diethylpropion
• Phentermine
• Phendimetrazine
• Long term
• Orlistat (OTC)
• Phentermine/topiramate
• Naltrexone/bupropion
• Liraglutide
• Semaglutide
• Tirzepatide
• $30 $1,560
• $27 $1,404
• $25 $1,300
• $23 $1,170
• $54 $2,808
• $50 $2,600
• $165 $8,580
• $315 $16,368
• $1,349 $70,148
• $1,023 $53,198
Future Projections
• 6M prescriptions * $50,000 = $300 Billion
• 20M prescriptions * $50,000 = $1 Trillion
• CMS Annual Budget = ~$1 Trillion
1. Yanovski SZ, Yanovski JA. Long-term drug treatment for obesity: a systematic and clinical review. JAMA. 2014 Jan 1;311(1):74-86.
2. Hampp C, Kang EM, Borders-Hemphill V. Use of prescription antiobesity drugs in the United States. Pharmacotherapy. 2013 Dec;33(12):1299-307.
3. Nor Hanipah Z, Nasr EC, Bucak E, Schauer PR, Aminian A, Brethauer SA, Cetin D. Efficacy of adjuvant weight loss medication after bariatric surgery. Surg Obes Relat Dis. 2018 Jan;14(1):93-98.
Outline
• Fun Facts (and non-fact phenomena)
• Definitions
• History of AOMs
• Current Pharmacopeia
• Mechanism/Dosing
• Effectiveness
• Side Effects/Adverse Events
• Usage
• Implications for Anesthesia and Surgery
GLP-1 RA Implications
for Bariatric Surgery
• Most effective weight loss medications to date
• Side effects better-tolerated or less severe than earlier medications
• More patients will be asking and using these before and after surgery
• Insurance coverage will continue to vary
GLP-1 RA Implications
for Bariatric Surgery
• Durability of effects dependent on
continued use
• Effectiveness does not surpass that of
bariatric surgery
• Opportunity for on-ramp to
comprehensive weight management
programs
• Some effects of bariatric surgery are
GLP-1 independent
Drucker DJ. Mechanisms of Action and Therapeutic Application of Glucagon-like Peptide-1.
Cell Metab. 2018 Apr 3;27(4):740-756.
GLP-1 RA Implications
for Bariatric Surgery
• May eventually increase bariatric surgery utilization
• Important adjunct (adjuvant therapy) for bariatric surgery
• TBWL of 6-9% with GLP-1 RAs
• 5 years after bariatric surgery
• Weight regain
• Ineffective weight loss
• Relationship between GLP-1 RAs and bariatric surgery needs further study
1. Lautenbach A, Wernecke M, Huber TB, Stoll F, Wagner J, Meyhöfer SM, Meyhöfer S, Aberle J. The Potential of Semaglutide Once-Weekly in Patients Without Type 2 Diabetes with Weight Regain or
Insufficient Weight Loss After Bariatric Surgery-a Retrospective Analysis. Obes Surg. 2022 Oct;32(10):3280-3288.
2. Jensen AB, Renström F, Aczél S, Folie P, Biraima-Steinemann M, Beuschlein F, Bilz S. Efficacy of the Glucagon-Like Peptide-1 Receptor Agonists Liraglutide and Semaglutide for the Treatment of
Weight Regain After Bariatric surgery: a Retrospective Observational Study. Obes Surg. 2023 Apr;33(4):1017-1025. doi: 10.1007/s11695-023-06484-8. Epub 2023 Feb 11. PMID: 36765019; PMCID:
PMC9918402.
Conclusions
• Historical use of AOMs has been low
• Limited by significant side effects, small effect size, temporary results
• Out-of-pocket payment has been the norm
• Recent GLP-1 RAs are the most effective AOMs to date
• Opportunity to strengthen comprehensive weight management
• Risk of another fad or boom/bust cycle
• Patients will want to know our recommendations
Questions