ESPE Abstracts

Objective: Hypothalamic obesity does not respond well to conventional interventions for obesity. Glucagon-Like Peptide 1 (GLP-1) receptor agonists have mechanisms independent of the hypothalamus which may be potentially beneficial for managing hypothalamic obesity. This systematic review summarizes the efficacy and safety of GLP-1 receptor agonists use in hypothalamic obesity.

Design: A PRISMA-compliant systematic review was performed. Data was extracted from included studies and analysed based on change in weight, body mass index, glycaemic control, satiety, and safety profile with GLP-1 receptor agonist use.

Results: Ten studies comprising 5 case reports, 4 case series and 1 randomized-controlled trial (RCT) included 54 patients (24 males, 30 females) with mean age of 25.2 (range 13-71) years with hypothalamic obesity who had received GLP-1 receptor agonists (exenatide = 48, liraglutide = 5 and dulaglutide = 1) over a mean duration of treatment of 12 (range 3-51) months. Craniopharyngioma was the commonest aetiology for HO, affecting 42 patients (77.8%); 8 had other forms of suprasellar tumours including germinoma, 2 had astrocytoma, 1 traumatic brain injury and 1 cerebral aneurysm with hypothalamic involvement. For associated comorbidities, 45 (83.3%) patients had panhypopituitarism, while 13 (24.0%) had concurrent T2DM at the time of initiation of treatment. Mean weight reduction of 7.4 (S.D. 7.92) kg was observed in patients who received GLP-1 receptor agonist, in whom weight was reported, with 85.7% of patients experiencing weight loss. All patients on liraglutide had experienced weight reduction post-therapy. The sole RCT had reported a non-significant reduction in BMI post-exenatide. Glycaemic control had either improved/ maintained in all patients in whom this was measured. The main side effects of GLP-1 receptor agonist in individuals with hypothalamic obesity were nausea and vomiting; there were no major safety concerns.

Conclusions: Based on limited published experience to date, GLP-1 receptor agonists may be effective and safe for weight control in hypothalamic obesity, with the added benefit of improved glycaemic control in those with concurrent diabetes mellitus.