Efficacy of anti-obesity medication (AOM) and endoscopic gastric remodeling (EGR): Analysis of combination therapy with optimal timing and agents

<b>Background and study aims</b> Endoscopic gastric remodeling (EGR) and anti-obesity medications (AOMs) are effective weight loss therapies. While the efficacy of EGR and AOMs has been established, the effect of combination therapy and its optimal approach remain unknown. <b>Patients and methods</b> This was a single-center retrospective review of prospectively collected data from patients who underwent EGR. Patients were categorized as: 1) monotherapy - EGR alone; 2) combination therapy - an AOM prescribed within 6 months of EGR; and 3) sequential therapy - an AOM prescribed greater than 6 months of EGR. Outcomes included percent total weight loss (%TWL) at 12 months, response rate (≥ 10%TWL at 12 months), and serious adverse event rate. <b>Results</b> A total of 208 patients were included. Of them, 65 (34%), 61 (31%), and 82 (35%) underwent monotherapy, combination therapy, and sequential therapy, respectively. At 12 months, patients who received EGR+GLP-1RA combination therapy achieved the greatest weight loss (23.7±4.6% TWL), while those who began with AOM followed by EGR more than 6 months later had the lowest weight loss (12.0±7.7%TWL) compared with monotherapy (17.3±10.0% TWL) ( <i>P</i> = 0.04 and 0.03, respectively). The response rate was 100% for EGR+GLP-1RA combination therapy and 56% for AOM followed by EGR sequential therapy ( <i>P</i> = 0.02). <b>Conclusions</b> Combining AOM with EGR appears to result in greater weight loss compared with other strategies, with GLP-1RA as the preferred agent and optimal initiation of both therapies occurring within 6 months of each other. Prolonged medication use prior to EGR appears to be associated with suboptimal weight loss, suggesting the importance of early referral for adjunctive therapy.