Small study finds GLP-1 drug can curb excess alcohol use

Novo Nordisk's GLP-1 receptor agonist semaglutide has been shown to help people struggling with alcohol use disorder (AUD) reduce the amount they drink – pointing to yet another potential use for the versatile drug class.

The small, 48-subject study – published in the journal JAMA Psychiatry – compared weekly injections with a low dose of semaglutide (0.25mg) to placebo over a nine-week period and found significant reductions in both alcohol consumption and cravings with the GLP-1 drug.

The researchers found that semaglutide treatment did not affect average drinks per calendar day or number of drinking days over that period, but significantly reduced the number of drinks consumed on those days that the subjects chose to drink.

They also discovered that cigarette use declined among a subgroup of smokers in the study, lending weight to the hypothesis that the GLP-1 may reduce craving for alcohol and nicotine via a similar mechanism to its ability to reduce food cravings and help people achieve weight loss.

Even though the study used the starting dose of semaglutide in diabetes formulation Ozempic – the lowest on the market – the results suggest the drug could be more effective than drugs currently used to treat people with AUD.

Senior author Klara Klein, of UNC School of Medicine in the US, said that, while a prior clinical trial of an older GLP-1 drug for AUD was inconclusive, "as prescription of semaglutide and similar medications escalated, anecdotal reports of reduced alcohol use became very common."

The team have called for large-scale trials to explore the potential of semaglutide and other GLP-1-acting drugs in AUD, which claims an estimated 178,000 deaths per year in the US, with relatively few people seeking treatment for the disorder.

There is still much to be learned about how the drugs may be used; in particular, whether their effects on alcohol intake and craving extend beyond the treatment phase. If so, the dosing and duration of treatment that could help people abstain in the long term will need to be worked out.

The study also enrolled individuals with higher body mass index (BMI) scores – at least 23 and most above 30, putting them into the range for obesity, according to Prof Matt Field, Professor of Psychology at the University of Sheffield in the UK, who said: "It will be important to establish if semaglutide can also reduce alcohol consumption in people who are not obese, particularly given that many people who seek treatment for alcohol problems are underweight."

The National Institute on Drug Abuse (NIDA) is running another small study on semaglutide in AUD that includes the use of virtual reality (VR) to simulate a bar environment, while the University of Colorado has an ongoing 135-patient trial of oral semaglutide (Rybelsus) in people seeking treatment for AUD.

Novo Nordisk itself, meanwhile, recently started a phase 2 study of CagriSema – its combination of semaglutide with dual amylin and calcitonin receptor agonist cagrilintide – that will investigate its effects on liver damage progression and alcohol intake in participants with AUD. The study will also look at monotherapy with semaglutide and cagrilintide and include a placebo group.

Meanwhile, a team at Brigham and Women's Hospital in Boston is running a four-week pilot study comparing Eli Lilly's dual GIP/GLP-1 tirzepatide to placebo in around 20 AUD patients, focusing on craving assessments.

Photo by Orkhan Farmanli on Unsplash