RYGB reduces medication use compared to sleeve gastrectomy
Roux-en-Y gastric bypass was associated with a slightly higher incidence of discontinuing diabetes, hypertension or hyperlipidaemia medication five years after surgery vs sleeve gastrectomy, according to the outcomes pf a study led by researchers from the University of Michigan, Ann Arbor. The findings were featured in the paper, ‘Medication Use for Obesity-Related Comorbidities After Sleeve Gastrectomy or Gastric Bypass’, published in JAMA.
The authors noted that although both procedures can result in significant weight loss the differences in long-term comorbidity resolution - such as diabetes, hypertension and hyperlipidaemia - are unclear. Therefore, they performed a study to assess the long-term comparative effectiveness of both procedures with regard to the incidence of medication discontinuation for diabetes, hypertension and hyperlipidaemia among Medicare patients. In addition, they examined the incidence of medication restart after discontinuation to assess the durability of medication discontinuation. The primary outcome was discontinuation of all diabetes, hypertension or hyperlipidaemia medications for any reason (defined as at least a six-month lapse in claims for a medication refill after the previous medication fill).
In total, there were 95,405 patients included in the study (71,348 (74.8%) women) and three cohorts were generated according to diabetes, hypertension, and hyperlipidaemia medication use. Rates of medication restart were then calculated among the 59,756 patients who discontinued medication.
In the diabetes cohort, there were 30,588 patients (16,809 SG patients and 13,779 RYGB patients). The outcomes showed that RYGB patients (74.7%) were more likely to discontinue diabetes medication up to five- years after surgery vs. SG patients (72.0%). The median (IQR) duration of diabetes medication discontinuation among patients who discontinued medication was 866 (336-1587) days for patients in the gastric bypass group and 578 (244-1109) days for patients in the sleeve gastrectomy group (p<0.001).
In the hypertension cohort, there were 52,081 patients (31,126 SG patients and 20,955 RYGB patients). Patients who had RYGB were more likely to discontinue antihypertensive medication (53.3%) compared to sleeve gastrectomy (49.4%). Among the 21,611 patients who discontinued antihypertensive medication, those who underwent gastric bypass had a lower likelihood of restarting medication at one year however, the difference became non-significant at three and five years.
In the hyperlipidaemia cohort, there were 35,055 patients (20,654 sleeve gastrectomy patients and 14,401 RYGB patients) and RYGB patients were more likely to discontinue lipid-lowering medication at one year after surgery however, this was non-significant at three and five years. The adjusted five-year cumulative incidence of hyperlipidaemia medication discontinuation was 64.6% for RYGB patients vs 61.2% for the sleeve gastrectomy patients.
“Overall, we believe these results demonstrate that both procedures are associated with long-term discontinuation of obesity-related medication and suggest that patients who underwent gastric bypass may be slightly more likely to remain free from their diabetes, antihypertensive and lipid-lowering medications,” the authors concluded. “Long-term prospective trials are needed to explain the mechanisms and factors associated with the differences in medication discontinuation and comorbidity resolution after bariatric surgery.”
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