Preoperative GLP-1 Receptor Agonist (GLP-1 RA) Exposure Is Associated With Postoperative Initiation of GLP-1 RA Following Metabolic Bariatric Surgery: A Multicenter Cohort Study.
This multicenter retrospective cohort study used the TriNetX database to examine whether preoperative exposure to GLP-1 receptor agonists (GLP-1 RAs) was associated with postoperative GLP-1 RA use following metabolic bariatric surgery (MBS). Researchers identified adults who underwent MBS and applied 1:1 propensity score matching to compare those with and without preoperative GLP-1 RA exposure (n = 2,811 per group). The study found that patients with prior GLP-1 RA exposure had more than twice the rate of postoperative GLP-1 RA initiation (15.3% vs. 7.6%; HR: 2.14, 95% CI: 1.81–2.52). The exposure group also showed a modestly higher prevalence of suboptimal weight control post-surgery (HR: 1.18), though rates of suboptimal glycemic control, hospitalization, and emergency department visits did not differ significantly between groups. These patterns were consistent across surgical subtypes and age groups. The authors interpret the findings as identifying a distinct patient phenotype with greater treatment complexity rather than a direct causal relationship. Key limitations include the retrospective design, reliance on a claims-based database, and potential residual confounding despite propensity score matching.
Why this grade: While conducted in humans with a reasonably large propensity-matched sample, the retrospective observational design and reliance on a claims database introduce residual confounding and limit causal inference.
BACKGROUND: A substantial proportion of patients undergoing metabolic bariatric surgery (MBS) receive adjunctive pharmacotherapy for suboptimal weight outcomes. Preoperative glucagon-like peptide-1 receptor agonist (GLP-1 RA) exposure may characterize a treatment-resistant subgroup, yet postoperative pharmacotherapy patterns in this population remain poorly understood. METHODS: This multicenter retrospective cohort study used the TriNetX database to identify adults undergoing MBS, comparing patients with and without preoperative GLP-1 RA exposure using 1:1 propensity score matching. The primary outcome was GLP-1 RA initiation occurring one–two years after surgery. The secondary outcomes included suboptimal glycemic control (HbA1c ≥ 7%), suboptimal weight control (body mass index ≥ 35 kg/m2), hospitalization, and emergency department (ED) visits. RESULTS: In the propensity score–matched cohorts (n = 2,811 per group), patients with preoperative GLP-1 RA exposure demonstrated a higher observed rate of postoperative GLP-1 RA initiation than controls (15.3% vs. 7.6%; hazard ratio [HR]: 2.14, 95% confidence interval[CI]:1.81–2.52, p < 0.001). Suboptimal weight control was more prevalent in the exposure group (HR:1.18, p = 0.014), while suboptimal glycemic control, hospitalization, and ED visits showed no significant differences. Similar patterns were observed across surgical subtypes and age groups. CONCLUSION: Preoperative GLP-1 RA exposure was associated with a higher likelihood of postoperative GLP-1 RA initiation following MBS. Rather than reflecting a causal effect, this association likely identifies a distinct patient phenotype characterized by greater treatment complexity and a higher likelihood of requiring ongoing multimodal weight management after surgery.
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