IBC Oxford Poster Abstract 1 - Effectiveness of liraglutide in managing recurrent weight gain and suboptimal clinical response after bariatric surgery: a meta-analysis

Introduction Weight recurrence and suboptimal initial weight loss affect 20–30% of bariatric surgery patients, representing a critical clinical challenge with limited evidence-based management options. Liraglutide, a GLP-1 receptor agonist, has shown promise in post-bariatric populations, but the evidence remains fragmented. This systematic review and meta-analysis comprehensively evaluated liraglutide efficacy and safety in post-bariatric patients experiencing weight regain or inadequate initial weight loss. Methodology We conducted a systematic search of PubMed, Embase, Cochrane CENTRAL, and Web of Science from inception through July 2025, following PRISMA 2020 guidelines. The protocol was registered prospectively (PROSPERO: CRD420251053386). Studies evaluating liraglutide in post-bariatric adults with weight recurrence (>10% regain from nadir) or suboptimal response (<20% total weight loss or <50% excess weight loss) were included. Primary outcome was percentage total weight loss (%TWL) at end-of-treatment; secondary outcomes included proportion achieving ≥5% TWL and adverse event-related discontinuations. Random-effects meta-analysis was performed using R software, with pre-specified subgroup analyses by bariatric procedure type, liraglutide dose, treatment duration, and diabetes status. Meta-regression explored continuous variable relationships, and sensitivity analyses assessed robustness of findings. Results Seventeen studies (2012–2025) encompassing 1060 post-bariatric patients met inclusion criteria. Study designs included retrospective cohorts (58.8%), prospective cohorts (17.6%), randomized controlled trials (11.8%), and observational studies (11.8%). Risk of bias assessment revealed 29.4% low risk, 52.9% moderate risk, and 17.6% high risk studies. Patient demographics: mean age 47.6 ± 8.9 years, 82.4% female, baseline BMI 37.4 ± 6.3 kg/m², baseline weight 106.2 ± 17.1 kg. Bariatric procedures comprised sleeve gastrectomy (42%), Roux-en-Y gastric bypass (38%), and mixed/other procedures (20%). Mean time from surgery to liraglutide initiation was 3.2 ± 1.8 years. Pooled %TWL was 8.24% (95% c.i.: 6.71–9.77, z = 10.82, P < 0.001) with substantial heterogeneity (I² = 89.7%, τ² = 12.34). Statistical significance was achieved in 15/17 studies (88.2%). Subgroup analyses revealed significant treatment modifiers: patients receiving liraglutide 3.0mg achieved superior weight loss compared to lower doses (8.91% versus 6.05%, χ² = 6.12, P = 0.013). Treatment duration demonstrated progressive improvement: ≤6 months (7.18%, 95% c.i.: 5.21–9.15), 7–12 months (8.95%, 95% c.i.: 6.33–11.57), >12 months (10.02%, 95% c.i.: 6.44–13.60; χ² = 6.32, P = 0.042). Roux-en-Y gastric bypass patients showed superior response compared to sleeve gastrectomy recipients (10.87% versus 7.80%, χ² = 10.27, P = 0.007). Studies with ≤50% diabetes prevalence demonstrated greater weight loss than those with >50% diabetes (9.15% versus 6.32%, χ² = 5.58, P = 0.018). Meta-regression analysis identified treatment duration as a significant predictor (β = 0.31% per month, 95% c.i.: 0.08–0.54, P = 0.009, R² = 0.41), while time since surgery showed negative association (β = −0.27, P = 0.017). Baseline BMI was not significantly associated with treatment response (β = −0.12, P = 0.42). Safety analysis across eight studies (n = 600) revealed adverse event-related discontinuation rate of 8.7% (95% c.i.: 4.2–15.3%) with high heterogeneity (I² = 92.6%). Common adverse events included nausea (29.1%), vomiting (11.3%), constipation (10.1%), and abdominal pain (8.7%). Sensitivity analyses excluding high-risk studies maintained similar results (8.41% weight loss). Publication bias assessment suggested potential asymmetry (Egger’s test P = 0.045), with trim-and-fill adjustment yielding 7.85% weight loss. Conclusion Liraglutide achieves clinically meaningful weight loss (8.24%) in post-bariatric patients experiencing weight recurrence or suboptimal initial response. Optimal outcomes are observed with maximum dose (3.0 mg), extended treatment duration, and in Roux-en-Y gastric bypass recipients. Earlier intervention post-surgery may enhance efficacy. The acceptable safety profile, comparable to general obesity populations, supports clinical utility. These findings provide evidence-based guidance for managing post-bariatric weight recurrence and identify key factors for optimizing therapeutic outcomes.