Gastric Bypass Tied to Modest Shift in Need for Comorbidity Meds

Gastric bypass seemed to help more people with obesity stop use of medications for certain comorbidities versus sleeve gastrectomy, researchers reported.

In an analysis of nearly 100,000 Medicare beneficiaries, those who opted for laparoscopic Roux-en-Y gastric bypass had a slightly higher 5-year cumulative incidence for discontinuing medications when compared with those who underwent laparoscopic sleeve gastrectomy: About 75% of gastric bypass patients with a diabetes diagnosis at the time of surgery, and who were also were taking an antidiabetic agent, were able to discontinue their medication versus 72% of sleeve gastrectomy patients, according to Ryan Howard, MD, of the University of Michigan in Ann Arbor, and colleagues.

In addition, fewer gastric bypass than sleeve patients restarted their diabetes medication after discontinuing it within the 5 years after surgery (30.4% vs 35.6%), they stated in JAMA Surgery.

As for antihypertensive medications, 53.3% of gastric bypass patients and 49.4% of sleeve patients with an underlying hypertension diagnosis were able to quit taking them in the years following surgery. And of these discontinuers, about 67% of gastric bypass patients restarted an antihypertensive agent compared with about 71% of sleeve patients.

Similar patterns were also seen with lipid-lowering medications among those with an existing hyperlipidemia diagnosis at the time of bariatric surgery. About 65% and 61% of gastric bypass and sleeve patients were able to discontinue these meds after surgery, respectively. That being said, about 46% and 53% of bypass and sleeve patients restarted one of these lipid-lowering medications within the 5 years following bariatric surgery, respectively.

Howard and colleagues stated that “we believe these results suggest that both procedures are associated with long-term improved outcomes enabling obesity-related medication discontinuation and suggest that patients who underwent gastric bypass may be slightly more likely to remain off of medications for diabetes, hypertension, and hyperlipidemia after surgery compared with patients who underwent sleeve gastrectomy.”

In an accompanying invited commentary, Anita P. Courcoulas, MD, MPH, and Bestoun H. Ahmed, MD, both of the University of Pittsburgh Medical Center, called the study “unique,” but also said it was important to keep in mind that the large patient population consisted of Medicare beneficiaries, which made them about 10 years older than the population of bariatric surgery patients in most of the literature.

And while the researchers “focused completely” on medication discontinuation as a surrogate marker for comorbidity change, they said, this was still vital information since “many patients seek bariatric and metabolic surgery not only to achieve durable weight loss but also to relieve the burden of using multiple medications.”

“The measures used in this study may not be perfect surrogates, but the findings do help to inform prospective patients and their physicians about what they can relatively expect after undergoing either of the two most common bariatric surgical procedures,” Courcoulas and Ahmed said.

For this comparative effectiveness analysis, Howard’s group assessed patients who underwent bariatric between 2012 and 2018 and had a Medicare Part A, Part B, or Part D claim for diabetes, hypertension, or hyperlipidemia medication in the 6 months prior to surgery. The mean age was around 57; about 75% were female; and about 75% were white. A total of 30,588 patients were included in the diabetes cohort, 52,081 patients in the hypertension cohort, and 35,055 patients in the hyperlipidemia cohort.

All patients had an ICD-9 or ICD-10 diagnostic code for morbid obesity. Medication discontinuation was considered to be a minimum 6-month lapse in claims for a medication refill after the previous medication was filled, while a medication restart was defined as a pharmacy claim for that particular medication class following discontinuation.

The authors noted additional study limitations, such as the possibility that “patients who underwent gastric bypass developed a greater intolerance to oral medications, resulting in less medication use without comorbidity resolution.” Also, the study was subject to residual bias, and “Between group differences in mortality, Medicare disenrollment, and even medication compliance may confound the observed outcomes,” they stated.