Surgery Is Better Than Obesity Drugs For Some With MASLD

SAN DIEGO – In patients with metabolic syndrome associated with steatotic liver disease (MASLD), bariatric surgery appears to have a lower 5-year mortality risk than treatment with pharmacologic therapies such as glucagon-like peptide 1 (GLP-1) receptor agonists or sodium-glucose cotransporter 2 (SGLT2) inhibitors, new study results showed.

In a separate analysis of data from the same study, researchers also found that bariatric surgery alone had a lower risk of adverse cardiovascular events (MACEs) than the use of a GLP-1 or SGLT2 inhibitor or a combination of surgery and medicine.

“While weight loss medications have shown notable success, particularly in managing diabetes and helping to lose weight, bariatric surgery offers many important and non-invasive benefits. “There are differences in weight and metabolic health, which makes it a better option for some patients,” said Leith Ghani, DO, and internal medicine resident at the University of Arizona College of Medicine. – Phoenix.

Ghani presented the findings on the disease at The Liver Meeting 2024: American Association for the Study of Liver Diseases (AASLD). Co-author and fellow internal medicine resident Qumber Ali, DO, presented research on MACEs.

These findings highlight “the need for individualized treatment plans, which allow the decision between surgery and medication to be made according to the patient’s specific condition and health goals,” Ghani said. “It also emphasizes the importance of multidisciplinary patient management.”

Comparison of Bariatric Interventions with Pharmacologic Treatment

A recent, quantitative study of hospital admission data from the Banner Health system in Phoenix included more than 8600 patients who had diagnostic codes related to MASLD and metabolic criteria. Patients were divided into four groups according to the treatment they received: bariatric surgery alone (5.8%), GLP-1 medication (39.3%), SGLT2 inhibitor medication (23.4%), or a combination of surgery and medicine (31.5%).

In the death analysis, Ghani and colleagues looked at data for patients who died between 12 and 60 months after surgery or starting medication. They found that patients who underwent bariatric surgery were more likely to live 5 years.

Compared to bariatric surgery, the adjusted hazard ratio (aHR) for GLP-1 medication was 2.99, followed by aHR of 2.96 for SGLT2 inhibitor medication, and aHR of 1.78 for treatment with collective.

In the MACE study, Ali and colleagues looked at data on patients who were followed up 12 months or more after intervention or starting treatment, to identify criteria for diagnosing MACE for death. coronary artery disease, cerebrovascular disease, and congestive heart failure. They found that patients who underwent bariatric surgery alone had a significantly lower rate of MACE.

Compared to bariatric surgery, the aHR was 1.83 for GLP-1 medication, 1.72 for SGLT2 inhibitor medication, and 1.91 for combined therapy.

Regarding both tests, patients taking GLP-1 or SGLT2 inhibitor drugs may face higher risks of death or serious cardiovascular problems due to existing metabolic problems or heart disease, Ali said.

Future studies could look at other risk factors that make these patients more vulnerable, he added. For example, factors related to body mass index, glucose control, other medications, different clinical conditions, and race/ethnicity may contribute to different treatment responses, such as the decision to take medication or to spoken at the beginning.

“This emphasizes the need for further, prospectively randomized studies to determine why these differences exist,” Ali said. “Although progress has been made, there is still much to be learned about the proper management of patients with metabolic and cardiovascular disorders.”

Considerations for a Multidisciplinary Approach to the Treatment of MASLD

Ghani and Ali also call for individualized treatment plans for metabolic disorders such as MASLD, as well as a robust discussion among professionals and patients about the benefits and risks of choosing certain medications and procedures.

“Bariatric surgery is not a universal solution, and not all patients are suitable for surgery,” Ghani said. “Also we cannot say now that drug treatment is worse than bariatric surgery. The success of these treatments can vary greatly depending on the patient’s health, lifestyle and preferences.”

Looking ahead, MASLD studies should investigate the long-term weight loss seen with bariatric surgery and different medications, said Katherine Schwenger, PhD, RD, assistant professor of medicine at the General Hospital of Toronto is in Toronto, Ontario, Canada, he said. Medscape Medical News.

Schwenger, who was not involved in the study, said: “GLP-1 levels are a concern now. But “we need to look at factors such as long-term weight loss. It is difficult to overcome the success and stability of bariatric surgery”.

Ghani, Ali, and Schwenger report no relevant disclosures.

Carolyn Crist is a health and medical journalist who reports on the latest studies for Medscape Medical News, MDedge, and WebMD.