A comparative analysis found that patients who underwent gastric bypass were associated with increased likelihood of discontinuing medication compared with patients who underwent sleeve gastrectomy (SL). These findings were published in JAMA Surgery.
Data for this study were sourced from the Medicare fee-for-service claims database. Patients (N=95,405) who underwent laparoscopic sleeve gastrectomy or laparoscopic Roux-en-Y gastric bypass (RYGB) between 2012 and 2018 were assessed for 6-month discontinuation of medications for diabetes, hypertension, or hyperlipidemia and for restart of medications after discontinuation.
The study population was 74.8% women and aged mean 56.6 (SD, 11.8) years.
Among the diabetes (n=30,588) cohort, 16,809 patients underwent SL and 13,779 RYGB. Up to 5 years after surgery, RYGB was associated with increased odds of discontinuing medications for diabetes (adjusted hazard ratio [aHR], 1.30; 95% CI, 1.12-1.51). This corresponded with adjusted 5-year cumulative medication discontinuation incidence rates of 74.7% and 72.0% among the RYGB and SL cohorts, respectively.
For the subset of patients who discontinued diabetes medication use (n=19,599), RYGB recipients had lower odds of restarting medication use at 5 years (aHR, 0.78; 95% CI, 0.63-0.96), corresponding with a median discontinuation duration of 866 and 578 days (P <.001) for the RYGB and SL groups, respectively.
Among the hypertension (n=52,081) cohort, 31,126 patients underwent SL and 20,955 RYGB. Similar to the diabetes cohort, patients who underwent RYGB were associated with increased odds of discontinuing medications for hypertension (aHR, 1.31; 95% CI, 1.18-1.45), with rates of discontinuation of 53.3% for RYGB and 49.4% for SL at 5 years. Among the patients who discontinued antihypertension medication use (n=21,611), restarting medication use at 1 year after discontinuation was less likely among the RYGB cohort (aHR, 0.81; 95% CI, 0.73-0.89). There were no group differences at years 3 or 5.
The hyperlipidemia cohort consisted of 35,055 patients who underwent SL (n=20,654) or RYGB (n=14,401). At year 1, medication discontinuation was associated with RYGB (aHR, 1.28; 95% CI, 1.16-1.40). No group differences were observed at years 3 and 5. Among the subset of patients who discontinued medication use (n=18,546), RYGB was associated with decreased odds of restarting medication use up to 5 years (aHR, 0.44; 95% CI, 0.38-0.50). The median duration of lipid-lowering medication discontinuation was 647 days for the RYGB cohort and 345 days for the SL cohort (P <.001).
Interpreting these data may be confounded by the fact that discontinuing use of medications for comorbidities does not necessarily mean that patients had resolution of their disease symptoms.
The study authors concluded, “In this comparative effectiveness research study with a large cohort of Medicare beneficiaries with a high burden of medication use for obesity-associated diseases, both gastric bypass and sleeve gastrectomy were associated with a high incidence of medication discontinuation up to 5 years after surgery. Compared with sleeve gastrectomy, gastric bypass was associated with a slightly higher incidence of medication discontinuation and a slightly lower incidence of medication restart after discontinuation.”
Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.
Howard R, Chao GF, Yang J, et al. Medication use for obesity-related comorbidities after sleeve gastrectomy or gastric bypass. JAMA Surg. Published online January 12, 2022. doi:10.1001/jamasurg.2021.6898