Friday, July 22, 2016

Using Liraglutide in Combination with the Endobarrier

Over the past several years, four obesity drugs have gained FDA approval and become available for the treatment of obesity. These drugs are Qsymia, produced by Vivus, Belviq, produced by Arena, Contrave, produced by Orexigen and Saxenda (liraglutide), produced by Novo Nordisk. These drugs give bariatric service providers new options to use in the fight against obesity. Bariatric surgery procedures, including gastric bypass surgery, sleeve gastrectomy and the lap band, provide another set of tools that bariatric service providers may use. These tools also include endoscopic weight loss procedures. And combining one of these endoscopic tools with liraglutide to combat obesity is being investigated.

The endoscopic tool is the endobarrier. The  endobarrier is a malabsorptive endoscopic bariatric therapy (EBT) device. The device, produced by Lexington, MA based GI Dynamics, is a liner for a section of the small intestine. And similar to the gastric balloon, the endobarrier is inserted into the intestine endoscopically. The endobarrier is designed to act as a barrier between the food one eats and the intestinal walls. With the endobarrier inserted, food digestion is reduced in a fashion similar to gastric bypass surgery.

In a study consisting of 70 subjects, the endobarrier-plus-liraglutide group lost more weight than the endobarrier-alone group or the liraglutide-only group. Further, the endobarrier-plus-liraglutide group experienced the most reduction in HbA1c.

Combining bariatric surgical methods with obesity drugs is a natural progression in obesity treatment. One expert indicated that although surgery can be beneficial, the combination of surgery and medication can be even more beneficial.

And in another somewhat related small study, investigators found that weight gain after bariatric surgery was "significantly reduced after treatment with liraglutide." The researchers suggested that liraglutide may be a treatment for those persons who failed to lose much weight or who failed to maintain the weight loss.

We commonly view pharmacotherapy as a weight loss tool to be used in conjunction with diet and exercise. But the bariatric surgery-drug combination may be another feasible option. The combination could add to the obesity treatment arsenal.


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