Millions of obese Americans have achieved successful weight loss through the use of glucagon-like peptide-1 agonists (GLP-1), a game-changing class of obesity medications. Results are often dramatic, but lost weight can be quickly regained if patients stop taking the drug. Researchers are now investigating a possible long-term solution for weight maintenance through an innovative new outpatient endoscopic procedure, and a WVU Medicine team has taken a lead role as a national hub in the latest clinical trial.
As GLP-1 drugs, including tirzepatide (branded Mounjaro and Zepbound) and semaglutide (branded Ozempic and Wegovy), continue to revolutionize weight-loss treatment, patients using the medications often experience significant weight reduction. There is a trade-off: these powerful drugs may require long-term use to remain effective. Many patients stop these medications due to cost, side effects or personal preference and quickly see the lost pounds return.
As a lead site in the REMAIN-1 study, the WVU Medicine bariatric endoscopy team is evaluating the potential for duodenal mucosal resurfacing (DMR) to prevent weight regain after a patient stops using GLP-1 medications. DMR is an outpatient endoscopic treatment that targets the lining of the duodenum (the first part of the small intestine) to address obesity’s root causes and metabolic dysfunction, including diabetes.
WVU Medicine recently performed its first DMR procedure as part of REMAIN-1, Shailendra Singh, M.D., director of Bariatric Endoscopy and associate professor in the Division of Gastroenterology and Hepatology at the WVU School of Medicine, said. Dr. Singh is the WVU site’s principal investigator.
“We are excited to be part of the REMAIN-1 study and to offer this cutting-edge procedure to our patients,” Singh said. “With the start of this clinical trial, we aim to provide solutions for patients who either need to stop or wish to stop injectable weight loss medications like GLP-1 therapy.”
Those enrolled in the study will be given tirzepatide to lose at least 15 percent of their body weight. Once participants lose weight, they will be randomly assigned to receive either the DMR procedure or a sham procedure. As a designated national hub to perform DMR procedures, study patients enrolled in the Pittsburgh and West Virginia regions will be referred to WVU Medicine J.W. Ruby Memorial Hospital to undergo the procedure.
The first DMR procedure’s results were encouraging, Singh said. Four weeks after the patient underwent the outpatient treatment, none of the weight lost through the patient’s prior tirzepatide use was regained. The patient had previously achieved a 15 percent total body weight loss while using tirzepatide. Other studies have shown that patients who discontinue GLP-1 therapy experience an average three percent weight regain within four weeks of discontinuing the prescribed drugs.
“Obesity is a complex chronic condition, and the DMR procedure has the potential to redefine how we approach long-term weight maintenance,” Singh explained. “This aligns perfectly with our mission to offer innovative patient-centered care that addresses the real-world challenges our patients face.”
The WVU Medicine Bariatric Endoscopy program has been a pioneer in the exploration of innovative obesity treatments, addressing an epidemic that affects over 40 percent of the U.S. population. As leaders in the DMR procedure, WVU Medicine’s expert endoscopy team members have also used DMR as a participating institution in the REVITALIZE-1 clinical trial for diabetes care. The REMAIN-1 and REVITALIZE-1 studies are each sponsored by device manufacturer Fractyl Health.
For more information on endoscopic non-surgical weight loss at WVU Medicine, visit WVUMedicine.org/WVUEBT.
