Jennifer Byrne , 2025-05-06 14:39:00
Key takeaways:
- No significant differences were reported in mortality and cardiovascular outcomes between surgery and GLP-1 groups.
- The findings suggest GLP-1s may still improve outcomes for those who cannot undergo surgery.
SAN DIEGO — Bariatric surgery and GLP-1s conferred similar outcomes in mortality, adverse cardiovascular events and cirrhosis development in patients with diabetes, obesity and metabolic dysfunction-associated steatotic liver disease.
However, patients who underwent bariatric surgery had lower risk for chronic kidney disease, whereas those on GLP-1s had better hypertension outcomes, findings presented at Digestive Disease Week showed.
“This population of patients with obesity, diabetes, MASH or MASLD have complex disease, and oftentimes one treatment won’t be enough, or they’ll have a relapse and you’ll have to think about your next step,” C. Roberto Simons–Linares, MD, study author and director of bariatric endoscopy at Cleveland Clinic, told Healio. “One of the take-home messages of this study is that GLP-1s can be as beneficial as bariatric surgery for impacting mortality and progression of chronic liver disease and should be considered as a potential tool in the treatment toolbox.”
Methods
Simons-Linares and colleagues conducted a retrospective cohort study to compare outcomes among patients with MASLD or metabolic dysfunction-associated steatohepatitis, obesity (BMI 30 kg/m2) and type 2 diabetes who underwent bariatric surgery or received treatment with GLP-1s.
Eligible patients were identified using the TriNetX database between Jan. 1, 2014, and Dec. 12, 2023.
The researchers propensity-matched patients in the bariatric surgery group (n = 1,450) to those in the GLP-1 group (n = 30,788) based on age, demographics, socioeconomic factors, comorbidities and medications. The analysis included 1,441 patients in each cohort.
All-cause mortality, incidence of cirrhosis, major adverse cardiovascular events and chronic kidney disease at 5 and 10 years after intervention served as outcomes.
“The motivation behind this was to evaluate whether patients who might not have access to the gold standard — bariatric surgery — could use GLP-1s to tackle these diseases and see a benefit,” Simons-Linares said. “Oftentimes, these patients with complex, chronic, relapsing diseases need multimodal therapy. There’s no one-size-fits-all.”
Results
The researchers observed no significant differences in mortality and major cardiovascular outcomes between the two cohorts.
At 5 years, 11 patients (0.76%) had died in the bariatric surgery group vs. 10 patients (0.69%) in the GLP-1 group (HR = 1.316; 95% CI, 0.508-3.409). Eighty-five patients (5.9%) experienced major nonfatal cardiovascular events in the surgery group vs. 83 patients (5.76%) in the GLP-1 group (HR = 0.812; 95%CI, 0.599-1.1).
At 10 years, 11 patients (0.76%) had died in the surgery group vs. 10 patients (0.69%) in the GLP-1 group (HR =1.316; 95%CI, 0.508-3.409). Similarly, 89 patients (6.18%) experienced cardiovascular events in the surgery group vs. 85 (5.9%) in the GLP-1 group (HR = 0.806; 95% CI, 0.597-1.088).
However, patients who underwent bariatric surgery had significantly lower risk for chronic kidney disease at 5 years (n = 46 vs. 66; 3.19% vs. 4.58%; HR = 0.569; 95% CI, 0.39-0.831) and at 10 years (n = 50 vs. 70; 3.47% vs. 4.86%; HR = 0.552; 95% CI, 0.382-0.797) compared with those who received GLP-1s.
Conversely, patients in the GLP-1 group had lower risk for hypertension at 5 years (n = 799; 55.45%) than those in the surgery group (n = 863; 59.89%; HR = 1.19; 95% CI, 1.08-1.311). This finding remained consistent at 10 years (HR = 1.19; 1.08-1.311).
None of the patients developed cirrhosis at either timepoint.
“Both groups had decreased mortality and cardiovascular events, and the GLP-1 group had very striking results in mortality and disease progression, which was amazing to see,” Simons-Linares said. “They are comparable, meaning that if someone is not ready for bariatric surgery or cannot access it, you could start improving their outcomes with these medications.”
Simons-Linares hopes to see future studies evaluate this subject in a prospective setting with fewer patients.
“We needed to use a large database to get the number of patients we included in this study,” Simons-Linares told Healio. “Looking ahead, we may need to do this at a smaller scale, in a randomized study, and follow these patients prospectively to see whether they truly are comparable.”
For more information:
C. Roberto Simons–Linares, MD, can be reached at gastroenterology@healio.com.
Sources/Disclosures
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Naseem Z, et al. Outcomes in patients with type 2 diabetes with MASH and MASLD: A comparison between bariatric surgery and GLP-1 agonists. Presented at: Digestive Disease Week; May 3-6, 2025; San Diego.
Disclosures:
Simons-Linares reports no relevant financial disclosures.
