Journal watch 24/11/2021

Welcome to our weekly round-up of the latest bariatric and obesity-related papers published in the medical literature. As ever, we have looked far and wide to give you an overview of papers including an investigation into cagrilintide for weight management, a study evaluating the differences in computed tomography (CT) use between LRYGB patients with open and closed mesenteric defects, a study that found attending periodic follow-up visits does not appear to be associated with long-term weight loss outcomes, a study that found that out-of-pocket costs are US$122 less for SG than RYGB and early post-operative rapid weight loss as represented by six-month BMI loss was the main predictor of de novo cholelithiasis after bariatric surgery (please note, log-in maybe required to access the full paper).


Once-weekly cagrilintide for weight management in people with overweight and obesity: a multicentre, randomised, double-blind, placebo-controlled and active-controlled, dose-finding phase 2 trial

A team of international researchers, reporting in The Lancet, have found that cagrilintide treatment in people with overweight and obesity led to significant reductions in bodyweight and was well tolerated. Natural amylin is a pancreatic hormone that induces satiety and cagrilintide is a long-acting amylin analogue. In this study, the researchers assessed the dose–response relationship of cagrilintide regarding the effects on bodyweight, safety and tolerability.


The multicentre, randomised, double-blind, placebo-controlled and active-controlled, dose-finding phase 2 trial was conducted at 57 sites including hospitals, specialist clinics and primary care centres in ten countries (Canada, Denmark, Finland, Ireland, Japan, Poland, Serbia, South Africa, the UK, and the USA). PStudy participants were randomly assigned (6:1) to subcutaneous self-injections of once-weekly cagrilintide (0.3, 0.6, 1.2, 2..4 or 4.5mg), once-daily liraglutide 3.0mg or volume-matched placebo (for six placebo groups). The primary endpoint was the percentage change in bodyweight from baseline to week 26 and safety was assessed in all participants who received at least one dose of randomised treatment.


In total, 706 participants to cagrilintide 03–45 mg (100–102 per dose group), 99 to liraglutide 30 mg and 101 to placebo. According to the trial product estimand, mean percentage weight reductions from baseline were greater with all doses of cagrilintide (0.3–4.5mg, 6.0%–10.8%) versus placebo (3.0%); estimated treatment difference range 3.0%–7.8%; p<0.001). They also reported that weight reductions were also greater with cagrilintide 4.5 mg versus liraglutide 3.0 mg (10.8% vs 9.0; estimated treatment difference 1·8%, p=0·03).


The most frequent adverse events were gastrointestinal disorders (eg, nausea, constipation, and diarrhoea) and administration-site reactions. More participants receiving cagrilintide 0.3–4.5 mg had gastrointestinal adverse events compared with placebo (41%–63% vs 32%), primarily nausea (20%–47% vs 18%).


The study authors concluded that these findings support the development of molecules with novel mechanisms of action for weight management.


This study was funded by Novo Nordisk. This trial is registered with ClinicalTrials.gov, NCT03856047.


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The Influence of Mesenteric Defects Closure on the Use of Computed Tomography for Abdominal Pain 5 Years After Laparoscopic Gastric Bypass—a Post Hoc Analysis of a Randomized Clinical Trial

Investigators from Örebro University, Sweden, who evaluated the differences in computed tomography (CT) use between LRYGB patients with open and closed mesenteric defects and assessed the radiological findings and radiation doses, have report that the closure of mesenteric defects did not influence the use of CT to assess abdominal pain.


The study included 300 patients randomised to either closure (n=150) or non-closure (n=150) of mesenteric defects during LRYGB. The total number of CT scans performed due to abdominal pain in the first five postoperative years was recorded together with the radiological findings and radiation doses.


A total of 132 patients (44%) underwent 281 abdominal CT scans, including 133 scans for 67 patients with open mesenteric defects (45%) and 148 scans for 65 patients with closed mesenteric defects (43%). Radiological findings consistent with small bowel obstruction or internal hernia were found in 31 (23%) of the scans for patients with open defects and in 18 (12%) of the scans for patients with closed defects (p=0.014). At the five-year follow-up, the total radiation dose was 82,400 mGy cm in the non-closure group and 85,800 mGy cm in the closure group.


They reported their findings in Obesity Surgery.


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10-year weight loss outcomes after Roux-en-Y gastric bypass and attendance at follow-up visits: A single-center study

Reporting in SOARD, researchers from the Washington University School of Medicine in St. Louis have examined the long-term weight trajectory in patients undergoing Roux-en-Y gastric bypass (RYGB) and determined the factors predicting long-term follow-up and weight outcomes.

The study included 1,104 patients with a pre-operative BMI of 54.7 kg/m2. Follow-up data were available for 92.8% of the patients after 1 year, 50.0% after 5 years, and 35.2% after ten years post-surgery.


Black patients, compared to White individuals, were less likely to attend follow-up visits. Attendance at follow-up visits at least every other year was not associated with larger weight loss, but higher pre-operative BMI, being White (vs. Black) and female sex were. Predicted BMI reduction for a typical patient, a 45-year-old White female with a pre-operative BMI of 54.7 kg/m2 and private health insurance, undergoing laparoscopic RYGB in 2004, was 18.3 kg/m2 at year five and 17.6 kg/m2 at year ten, respectively.


The authors concluded that RYGB res