Amiodarone-induced Hyperthyroidism during Massive Weight Loss Following Gastric Bypass

Drug-Drug Interactions Between Glucagon-Like Peptide 1 Receptor Agonists and Oral Medications: A Systematic Review

BACKGROUND

Glucagon-like peptide 1 receptor agonists (GLP1RAs) are used in the treatment of diabetes and obesity. Their slowing effect of gastric emptying might change oral drug absorption, potentially affecting pharmacokinetics, particularly in the case of medications with a narrow therapeutic index.

PURPOSE

The purpose of this systematic review is to summarize data on drug-drug interactions between GLP1RAs and oral drugs.

DATA SOURCES

The PubMed and EMBASE databases were searched up to November, 1st 2023.

STUDY SELECTION

We selected pharmacokinetic studies of any injectable GLP1RA given with an oral medication, and product prescribing sheets reporting data without access to the original study.

DATA EXTRACTION

Two authors independently extracted the data.

DATA SYNTHESIS

Twenty-two reports and six prescribing sheets were included. Treatment with GLP1RAs resulted in unaffected or reduced Cmax and delayed tmax of drugs with high solubility and permeability (warfarin, contraceptive pills, acetaminophen), drugs with high solubility and low permeability (angiotensin converting enzyme inhibitors), drugs with low solubility and high permeability (statins) and drugs with low solubility and permeability (digoxin). However, the use of GLP1RAs did not exert clinically significant changes in the AUC or differences in clinically relevant endpoints.

LIMITATIONS

The major limitations of the studies that are included in this systematic review are the enrollment of healthy subjects and insufficient data in conditions that might affect pharmacokinetics (e.g., kidney dysfunction).

CONCLUSIONS

To conclude, reduced Cmax and delayed tmax of drugs co-administered with GLP1RAs are consistent with the known delayed gastric output by the latter. Nevertheless, the overall drug exposure was not considered clinically significant. Dose adjustments are probably not required for simultaneous use of GLP1RAs with oral medications. Still, results should be carefully generalized to cases of background kidney dysfunction or when using drugs with narrow therapeutic index. The study is registered in PROSPERO: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022332339 .

Perioperative Online Weight Monitoring in Bariatric Surgery with a Digital Internet-Connected Scale

INTRODUCTION

Strict follow-up after bariatric surgery is an important factor in achieving and maintaining weight loss, whereas regaining weight is the most important threat in long-term follow-up. Stagnation in weight loss or weight regain can be signals of early treatment failure. The aim of this study is to assess the possibility of obtaining frequent objective weight measurements using an Internet-connected home weighing scale.

METHODS

Internet-connected home weighing scales were used to perform weekly follow-up in bariatric surgery patients during the first postoperative year. For each patient, weight measurements were registered and excess body weight loss was calculated. This follow-up method was deemed successful if weight measurements were available for 80% of all weeks in the first year.

RESULTS

A total of 14 patients started the protocol. Seven patients (50%) performed weekly weight measurements for at least 80% of all weeks in the first year. One-year follow-up was available for 11 patients. Excess weight loss was >50% in nine (82%) of these patients and >40% in the remaining two.

CONCLUSIONS

Using an Internet-connected weighing scale at home is feasible in postsurgery bariatric patients. It can provide the treating physicians with valuable information about weight loss over time. This could possibly offer opportunities for timely interventions during follow-up in case of insufficient weight loss or weight regain.

Dynamics of change in total and regional body composition after gastric bypass in obese patients

Little is known on patterns of change over time in body composition, especially lean body mass (LBM), during massive weight loss after Roux-en-Y gastric bypass (RYGB) in obese patients. We performed sequential measurements of total and regional body composition in patients after RYGB, and we compared a subsample of patients after surgery to a nonsurgical control group of similar age and body fatness. We used dual-energy X-ray absorptiometry (DXA) before and at 3, 6, and 12 months after RYGB in 42 obese women (before surgery: age 39.5 +/- 11.6 years; BMI 44.6 +/- 6.1 kg/m(2); mean +/- s.d.) and in 48 control obese women referred for nonsurgical weight management, before weight loss. During 1-year follow-up after RYGB, there was a continuous decrease in body weight (-36.0 +/- 12.5 kg at 1 year), total fat mass (FM) (-26.0 +/- 9.1 kg), as well as in trunk and appendicular FM. In contrast, the decrease in total LBM (-9.8 +/- 4.8 kg at 1 year), as well as in trunk and appendicular LBM, plateaued after 3-6 months. Rates of loss in weight, FM, and LBM were highest during the first 3-month period after RYGB (6.4 +/- 1.8, 4.1 +/- 1.7, and 2.3 +/- 1.2 kg/month, respectively), then decreased continuously for FM but plateaued for LBM. There was no evidence of a decrease in total, trunk, or appendicular LBM in weight-reduced subjects compared to the control group. In conclusion, follow-up of these obese women revealed a differential pattern of change in FM and LBM after RYGB. Despite an important loss in LBM, especially during the 3-6 months of initial period, LBM appears to be spared thereafter.