RZY8JY68MG COMPARATIVE EFFECTIVENESS OF SEMAGLUTIDE AND TIRZEPATIDE vs BARIATRIC SURGERY

Abstract

Avery Brown NYU Langone Health; Suhani Patel NYU Langone Health; Alexander Eduardo Hien Vu NYU Langone Health; Eduardo Somoza NYC Health + Hospitals; Tony Mei NYU Langone; Megan Jenkins NYU Langone; Loic Tchokouani NYU Langone; Marina Kurian NYU Langone; Babak Orandi NYU Langone; Tatiana Figueredo-Dietes NYU Langone; Jeffrey Lipman NYU Langone; Julia Park NYU Langone; Patricia Chui NYU Langone; John Saunders NYU Langone; Allan Massie NYU Langone Introduction: GLP-1 receptor agonist (GLP1-RA) use is increasing exponentially. Few studies directly compare the effectiveness of the newer GLP1-RAs (semaglutide and tirzepatide) to bariatric surgery, the gold-standard treatment for obesity and diabetes. METHODS AND PROCEDURES: We identified 122,595 patients aged greater than or equal to 18 yo prescribed Injectable Semaglutide or Tirzepatide, compared to 18,136 patients who underwent minimally invasive sleeve gastrectomy or Roux en-Y gastric bypass at two large urban health systems from 2018-2024. %Total weight loss (%TWL) and HbA1C were followed for 2 years posttreatment. To account for GLP1-RA discontinuation, we performed intention-to-treat (any patients prescribed at least 6 months’ GLP-RA) and per-protocol (only patients with continuous GLP1-RA orders) analyses using 1:1 propensity matching on age, baseline BMI greater than or equal to 35, and HbA1c. Results: 14,152 propensity matched patients were studied. GLP1-RA patients had significantly higher rates of diabetes, hyperlipemia, and COPD compared to surgery patients. In the intention-to-treat analysis (N=7076 GLP1-RA vs. 7076 surgery), bariatric surgery was associated with more weight loss at all time points (2 year %TWL -25.7±14.9 for surgery vs. -5.3±10.5 for GLP1-RA, p<0.001). In the per-protocol analysis (146 GLP1-RA, 146 bariatric surgery), the difference in outcomes was attenuated, but surgery patients still had significantly more weight loss at all time points (2 year weight loss -24.6±13.9 for surgery vs.-7.6 ±11.1 for GLP1-RA, p<0.001). Bariatric surgery was associated with superior HbA1c control (2 year change -0.2 points vs -0.5 points, p<0.001). Conclusions: Bariatric surgery is associated with superior sustained, long term weight loss and diabetes control compared to GLP-1RAs among patients eligible for both options.