Early Adjuvant Treatment with Semaglutide After Sleeve Gastrectomy in Patients with Class II-III Obesity: A Prospective Non-Randomized Controlled Study.

BACKGROUND: Weight management remains a significant challenge for patients with class II-III obesity, even after metabolic bariatric surgery (MBS). This study aimed to investigate the association between early, short-term adjunctive semaglutide therapy and postoperative weight-loss outcomes after laparoscopic sleeve gastrectomy (LSG) in patients with class II-III obesity. METHODS: In this prospective, non-randomized controlled clinical study, patients with class II-III obesity, defined as a body mass index (BMI) ≥ 35 kg/m² scheduled for LSG were enrolled. Semaglutide was administered as adjunctive therapy in the treatment group from 1 to 6 months postoperatively, while the control group received LSG alone. The primary outcome was the percentage of total weight loss (%TWL) at 12 months after surgery. The main secondary outcomes included the percentage of excess weight loss (%EWL) at 12 months, the %TWL and %EWL at 6 months, the distributions of %TWL and %EWL, and metabolic parameters. Exploratory analyses were also performed for body composition parameters. RESULTS: A total of 103 participants were included in the study, including 48 in the treatment group and 55 in the control group. At 12 months postoperatively, patients in the treatment group showed significantly greater weight loss than the control group, as reflected by a larger %TWL (-35.14 ± 6.88% vs. -30.73 ± 6.91%, P = 0.002) and a higher %EWL (86.42 ± 19.94% vs. 76.87 ± 22.95%, P = 0.026). Similarly, at 6 months postoperatively, %TWL was significantly greater in the treatment group (-29.74 ± 5.38% vs. -26.32 ± 4.10%, P < 0.001), whereas no significant between-group difference in %EWL was observed at 6 months. In addition, the distributions of %TWL and %EWL were more favorable in the treatment group. These results were generally consistent after propensity score adjustment for baseline confounders, although the between-group difference in %EWL distribution was not significant. Both groups showed comparable improvements in metabolic indicators from baseline. Exploratory analyses further showed a greater increase in lean body mass percentage and a greater reduction in visceral fat area in the treatment group, although these body composition findings should be interpreted cautiously. CONCLUSION: This non-randomized, single-center study indicates that, among patients with a BMI ≥ 35 kg/m, early adjunctive semaglutide therapy initiated at one month and continued until six months after LSG was associated with greater weight loss at one year postoperatively. These findings provide hypothesis-generating evidence for the potential role of early short-term adjunctive semaglutide therapy after MBS in this population.