What’s particularly encouraging is that the benefit appears to increase over time rather than fade, and that it behaves like a drug in terms of dose response. That gives us confidence that we’re targeting the right biology.
Shelby A. Sullivan, MDA study led by a Dartmouth Health gastroenterologist showed that an outpatient procedure may help some patients maintain weight loss achieved with the help of GLP-1 medications. While most GLP-1 patients regain the weight they lost within 18 months of stopping the medication, 70% of participants who underwent duodenal mucosal resurfacing (DMR) successfully kept the weight off.
“As effective as GLP-1 medications are, many people stop taking them because of cost, side effects or simply not wanting to take a drug long-term,” said Shelby A. Sullivan, MD, director of the Endoscopic Bariatric and Metabolic Program at Dartmouth Health’s Weight Center and professor of medicine Dartmouth’s Geisel School of Medicine, principal investigator of the REMAIN-1 trial. “But if they stop these medications, weight regain occurs in the vast majority of patients, and the metabolic benefits are lost. Finding a treatment that allows patients to stop these medications without weight regain or loss of metabolic benefit is a huge unmet need. These findings indicate that this minimally invasive procedure may provide lasting weight-loss maintenance.”
The duodenum is the first section of the small intestine, and the duodenal mucosa is its innermost lining. The typical Western diet many Americans consume has been linked to hyperplasia (an increase of cells in an organ, causing it to expand) and dysfunction in the lining, putting an individual at increased risk of type 2 diabetes and/or obesity. DMR is an investigational endoscopic procedure that uses targeted heat to ablate (burn) the unhealthy lining of the duodenum.
In Sullivan’s trial, patients lost an average of 40 pounds. Of the 45 participants, 29 underwent DMR and the remaining 16 had a placebo procedure. All participants underwent their procedure after they lost at least 15% of their total body weight using tirzepatide, a GLP-1 better known by the brand name and Zepbound. Six months after stopping the drug, those who had the sham procedure regained 40% more weight than those who underwent DMR. Moreover, those who had more of their duodenal mucosa resurfaced regained an average of only seven pounds, maintaining over 80% of their weight loss, while the sham control group regained about double that amount. The difference between the treatment and control groups appears to be widening from one to six months post-intervention, suggesting the potential for durable weight maintenance with the procedure.
“What’s particularly encouraging is that the benefit appears to increase over time rather than fade, and that it behaves like a drug in terms of dose response,” Sullivan said. “That gives us confidence that we’re targeting the right biology.”
Of the participants who had DMR, none reported serious complications from the procedure.
“Other than recovering from the general anesthesia, there isn’t much recovery time involved,” Sullivan said. “You can be back to your daily routine in about a day. Participants could not tell if they had the sham or real procedure because there are not a lot of symptoms after the procedure.”
Sullivan will present the trial’s findings at the Digestive Disease Week conference next week. To learn more about the study, visit clinicaltrials.gov/study/NCT06484114.
About Dartmouth Health
Dartmouth Health, New Hampshire’s only academic health system and largest private employer, serves patients across New England. Dartmouth Health provides access to more than 2,300 providers in nearly every area of medicine, delivering care at its flagship hospital, Dartmouth Hitchcock Medical Center (DHMC) in Lebanon, NH. Its network of hospitals, outpatient centers, clinics and home care facilities, spans a broad geographical area. Year after year, DHMC is named the #1 hospital in New Hampshire by U.S. News & World Report, and is consistently recognized for high performance in numerous clinical specialties and procedures. Dartmouth Health includes Dartmouth Cancer Center, northern New England’s only National Cancer Institute-designated Comprehensive Cancer Centers and one of less than than 60 total nationally; Dartmouth Health Children’s, which includes the state’s only children’s hospital (Children’s Hospital at DHMC/CHaD) and more than 20 locations around the region; eight member hospitals in Lebanon, Keene, Claremont, Hampstead, and New London, NH, and Windsor and Bennington, VT; Dartmouth Health Home Care; Dartmouth Health Connected Care Center for Telehealth, serving patients as far away as Texas; and more than 30 primary and multi-specialty clinics across New Hampshire and Vermont. Through its partnership with Dartmouth College, Dartmouth’s Geisel School of Medicine and the White River Junction VA Medical Center, Dartmouth Health trains nearly 400 medical residents and fellows annually and performs cutting-edge research and clinical trials with international impact. Dartmouth Health and its more than 16,000 employees are committed to serving the healthcare needs of everyone in the communities it serves and to providing every patient with exceptional, state-of-the-art, personalized care. Learn more at dartmouth-health.org.