Hic-hic hurray for GLP-1? Obesity drug sharply cuts drinking days in alcoholics

A study published in The Lancet reports that weekly semaglutide injections reduced heavy drinking in adults with obesity and alcohol use disorders. The findings add to growing interest in GLP-1 drugs beyond weight loss, though the study was small.

In Short

• Researchers tracked 108 adults with obesity seeking treatment for alcohol dependence
• Participants received cognitive behavioural therapy alongside weekly semaglutide injections or placebo
• Average heavy drinking days fell from seventeen to five after six months

The blockbuster weight-loss medications, which, over the last years, are also being studied deeply for their effect beyond obesity and diabetes, have been nicknamed as A-Z medicines, for the promise they offer for a range of metabolic conditions.

This promise just got more concrete as a new and important study has now shown that GLP-1-based drugs led to a dramatic reduction in heavy drinking days in people with alcohol use disorder and obesity.

Alcohol use disorder, also called alcoholism, is a common medical condition in which people can’t stop drinking, even when drinking affects their health, puts their safety at risk and damages their personal relationships.

The results from the first randomised trial assessing the efficacy of obesity drugs in alcoholism say that once-weekly semaglutide injection reduced heavy drinking days in the past 30 days by an average of roughly 12 days, 50 percent higher than the eight-day reduction seen in the placebo group.

The study has been published in The Lancet.

Semaglutide, like tirzepatide, is a GLP-1-based drug that mimics gut hormones and reduces appetite by promoting a feeling of fullness and slowing digestion.

A GLOBAL PROBLEM

The new study is based on a trial of 108 adults with obesity seeking treatment for alcohol use disorder.

Alcohol use disorder accounts for 5 percent of deaths worldwide annually, and the Lancet report says there is an urgent need for new treatments.

Worldwide, around 2.6 million deaths were caused by alcohol consumption in 2019. Of these, 1.6 million deaths were from noncommunicable diseases, 700, 000 deaths from injuries and 300,000 deaths from communicable diseases.

The World Health Organisation (WHO) says that an estimated 400 million people, or 7 percent of the world’s population aged 15 years and older, lived with alcohol use disorders.

Of this, 209 million people (3.7 percent of the world's adult population) lived with alcohol dependence.

Alcohol consumption, even at low levels, can bring health risks, but most alcohol-related harms come from heavy episodic or heavy continuous alcohol consumption.

The latest paper says that despite decades of research, the US Food and Drug Administration (FDA) has approved only three medications – disulfiram, acamprosate, and naltrexone1 – highlighting the urgent need for more effective treatments.

GLP-1 based drugs, approved for the treatment of diabetes and obesity, have gained wide attention for their effects on brain pathways involved with appetite regulation and reward, suggesting a potential use for mitigating alcohol consumption.

India saw the launch of injectable GLP-1 last year with Mounjaro, which has tirzepatide as its active ingredient, and Wegovy and Ozempic, both of which have semaglutide as an active ingredient getting rolled out locally.

These drugs became highly popular in India within months of launch.

In March this year, semaglutide, originally by Danish drugmaker Novo Nordisk, also went off-patent in India and was followed by a number of its generic versions hitting the market.

SEMAGLUTIDE AND ALCOHOLISM

The latest trial took place at a mental health centre in Denmark. All participants were offered cognitive behavioural therapy and were randomised to receive either a weekly dose of semaglutide or a placebo.

At the start of the trial, patients had on average 17 days of heavy drinking over the last 30 days. After six months, patients receiving semaglutide – a weekly injection of 2.4 mg dose- had an average of roughly five heavy drinking days over the previous 30 days, compared to nine days in the placebo group.

Additionally, at the start of the trial, participants had an average of approximately 2200g of alcohol over the previous 30 days, which decreased to roughly 650g/30 days with semaglutide and 1175g/30 days with placebo after six months.

“Semaglutide showed robust therapeutic effects in treatment-seeking participants with obesity and alcohol use disorder and this trial supports previous preclinical and clinical findings suggesting GLP-1 receptor agonists as a potential novel treatment target for alcohol use disorder,” wrote the authors.

They also highlighted key limitations, including that the study is small and there was no follow-up after the trial to see if alcohol consumption changed.

However, they say the study adds to the growing evidence for the use of GLP-1s in alcohol use disorders, potentially affecting millions of people, given the global rates of alcohol use disorder and obesity.

Alcohol consumption is found to play a causal role in more than 200 diseases, injuries and other health conditions, particularly liver diseases, heart diseases, and different types of cancers, as well as mental health and behavioural conditions such as depression,

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