司美格鲁肽治疗减重术后减重不足或体质量反弹患者有效性与安全性的Meta分析

Efficacy and safety of semaglutide in patients with insufficient weight loss or weight regain following bariatric surgery: a Meta-analysis

摘要:

背景与目的 大约20%~25%人群在减重术后出现减重不足（IWL）或体质量反弹（WR）的情况，而有关司美格鲁肽在减重术后患者中的应用研究较少，药物的有效性和安全性有待验证。因此，本研究通过系统评价探讨司美格鲁肽用于减重术后IWL或WR患者治疗的有效性和安全性，为临床决策提供证据支持。方法 计算机检索多个国内外数据库，收集关于司美格鲁肽在减重术后IWL或WR患者中应用的相关研究，检索时间为建库至2024年7月1日。按照纳入和排除标准筛选文献后，使用Stata 14.0软件进行分析。结果 最终共纳入5项研究，均为回顾性研究，共289例患者在减重术后接受了司美格鲁肽治疗。分析结果显示，与治疗前相比，司美格鲁肽使用后总体质量下降10.66%（MD=10.66%，95% CI=6.47%~14.89%）；患者体质量指数降低3.57 kg/m²（MD=3.57 kg/m²，95% CI=2.46~4.67 kg/m²）；不同手术方式对体质量下降程度不产生影响（P>0.05）；用药后体质量下降>5%患者所占比例为80%（OR=0.8，95% CI=0.76~0.85）、体质量下降>10%患者所占比例为45%（OR=0.45，95% CI=0.41~0.50）、体质量下降>15%患者所占比例为18%（OR=0.18，95% CI=0.08~0.27）；IWL或WR患者中以行胃袖状切除术为主（69.8%）；用药前后糖化血红蛋白水平差异无统计学意义（P>0.05）；药物不良事件发生率为14%（OR=0.14，95% CI=0.01~0.28），以胃肠道不良反应为主。结论 司美格鲁肽可以显著降低减重术后IWL或WR患者的体质量，且药物的不良反应发生率较低，可应用于减重术后体质量下降效果不理想的患者，但是仍需要前瞻性、大规模临床研究的进一步验证。

Abstract:

Background and Aims Approximately 20%-25% of individuals experience insufficient weight loss (IWL) or weight regain (WR) after bariatric surgery. However, there is limited research on using semaglutide in this patient population, and its efficacy and safety remain to be confirmed. Therefore, this study was conducted to evaluate the effectiveness and safety of semaglutide in patients with IWL or WR after bariatric surgery through a systematic review to provide evidence to support clinical decision-making.Methods A comprehensive search was conducted across multiple domestic and international databases for studies using semaglutide in patients with IWL or WR after bariatric surgery. The search period was from the database's inception to July 1, 2024. Relevant studies were screened according to inclusion and exclusion criteria, and data were analyzed using Stata 14.0 software.Results A total of 5 retrospective studies were included, encompassing 289 patients who received semaglutide treatment after bariatric surgery. The analysis showed that, compared to baseline, semaglutide use resulted in an average total weight reduction of 10.66% (MD=10.66%, 95% CI=6.47%-14.89%); body mass index decreased by 3.57 kg/m2 (MD=3.57 kg/m2, 95% CI=2.46-4.67 kg/m2); the type of surgery did not significantly affect the degree of weight loss (P>0.05). The proportion of patients who experienced >5% weight loss was 80% (OR=0.80, 95% CI=0.76-0.85); >10% weight loss was observed in 45% of patients (OR=0.45, 95% CI=0.41-0.50); and >15% weight loss occurred in 18% of patients (OR=0.18, 95% CI=0.08-0.27). Most patients had undergone sleeve gastrectomy (69.8%). There was no significant difference in HbA1c levels before and after treatment (P>0.05). The incidence of adverse events was 14% (OR=0.14, 95% CI=0.01-0.28), primarily gastrointestinal side effects.Conclusion Semaglutide can significantly reduce body weight in patients with IWL or WR after bariatric surgery, with a relatively low incidence of adverse effects. It may be considered for patients who experience suboptimal weight loss following bariatric surgery. However, further prospective and large-scale clinical studies are needed to confirm these findings.