P2786 - Early Initiation of Glucagon-Like Peptide 1 Receptor Agonists After Transoral Outlet Reduction is Associated With Better Outcomes

Christine Lam, PhD¹, Cynthia Okafor, BS², Elizza E. Villarruel, BS³, Firas Bahdi, MD¹, Sagar Shah, MD¹, Philip Kozan, MD¹, Manar Alhanaee, MD¹, Basak Kanlilar-Ruiz, NP¹, Alireza Sedarat, MD¹, Adarsh Thaker, MD¹, Venkataraman R. Muthusamy, MD⁴, Danny Issa, MD^1
1David Geffen School of Medicine at UCLA, Los Angeles, CA; ²John Sealy School of Medicine at UTMB, Galveston, TX; ³David Geffen School of Medicine at UCLA, La Puente, CA; ⁴David Geffen School of Medicine at UCLA, Sherman Oaks, CA

Introduction: Transoral outlet reduction (TORe) and glucagon-like peptide 1 receptor agonists (GLP-1RA) have individually shown to be effective treatments for weight regain after bariatric surgery. However, many patients do not meet weight goals despite treatment. Pharmaceutical augmentation of weight loss with GLP-1RA after TORe may be a potential therapeutic strategy for these patients. To our knowledge, very few studies evaluated TORe and GLP-1RA combination, and it is unclear how these two treatments should be timed. Our study aims to assess and compare the efficacy of early initiation vs late initiation of GLP-1RA after TORe.

Methods: A retrospective single-center study was conducted on obese patients who were treated with both TORe and GLP-1RA for management of weight recidivism after roux-en Y gastric bypass. Thirty-seven patients were identified; 34 were treated sequentially with TORe, then GLP-1RA. Patients were divided into two groups: 1) an “early” group in which a GLP-1RA was initiated < 1 year after TORe and 2) a “late” group in which a GLP1-RA was initiated >1 year after TORe. Weight was measured at 1,3,6, and 12 months after GLP-1RA initiation and therefore receipt of both treatments. Primary outcome was total body weight loss (TBWL). Baseline characteristics and primary outcome were compared before and up to 12 months of GLP treatment.

Results: Patients in early and late groups had similar baseline characteristics including baseline weight, sex, race, ethnicity, comorbidities. Early group was older and experienced more pulmonary disease and dumping than late group (Table 1). Late group had lower weight after TORe and prior to GLP-1RA initiation, potentially indicating that they had lost more weight than early group with TORe, but this was not statistically significant. Time in between TORe and GLP-1RA was significantly different between groups. The mean TBWL% of early group were: 6.6 ±7.0 at 1mo, 8.3 ±10.2 at 3mo, 13.9 ±13.3% at 6mo, 18.5 ± 21.6 at 12mo. The mean TBWL% of late group were: 10.6 ±13.3 at 1mo, 9.7±11.1 at 3mo, 14.3±12.3 at 6mo, 13.5±8.9 at 12mo. When comparing paired month-TWBL% measurements between groups, early group had better TBWL over time than late group (p< 0.0001), as shown in Figure 1.

Discussion: Initiating GLP-1RA within a year after TORe is associated with greater total body weight loss compared to a later initiation of medication. This finding may help guide clinicians in how they time treatments for weight regain after bariatric surgery.



Disclosures:


Christine Lam, PhD¹, Cynthia Okafor, BS², Elizza E. Villarruel, BS³, Firas Bahdi, MD¹, Sagar Shah, MD¹, Philip Kozan, MD¹, Manar Alhanaee, MD¹, Basak Kanlilar-Ruiz, NP¹, Alireza Sedarat, MD¹, Adarsh Thaker, MD¹, Venkataraman R. Muthusamy, MD⁴, Danny Issa, MD¹. P2786 - Early Initiation of Glucagon-Like Peptide 1 Receptor Agonists After Transoral Outlet Reduction is Associated With Better Outcomes, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.