GLP-1s may curb alcohol consumption in those with obesity

Key takeaways:

• In one randomized controlled trial, exenatide reduced alcohol consumption in people with obesity.
• Another study showed that participants taking dulaglutide had an increased likelihood of reduced alcohol consumption.

Some diabetes medications could help reduce alcohol consumption and alcohol-related health problems, particularly in those with obesity, results of a systematic review published in eClinicalMedicine suggested.

The results “appear promising but require further research before being incorporated into routine clinical practice,” Mohsan Subhani, a PhD fellow at the University of Nottingham in England, told Healio.

Excessive alcohol use remains a significant health problem in the United States. Healio recently reported that both overall and heavy alcohol use rose during the COVID-19 pandemic, with the increases continuing through 2022.

Recent evidence has suggested GLP-1 receptor agonists may have beneficial effects on alcohol intake but “a comprehensive assessment of their long-term efficacy, safety, and tolerability in patients with excess alcohol consumption and [alcohol use disorder] is necessary,” Subhani and colleagues wrote.

In the review, researchers assessed two randomized controlled trials, two qualitative studies and two observational studies — all published up to August 2024 — to determine the effects of GLP-1 receptor agonists on alcohol consumption, alcohol-related problems and health care events and brain reactions.

The six total studies included 88,190 participants (mean age, 49 years; 56.9% men), of whom 43.9% received GLP-1 receptor agonists. Only 286 people participated in the randomized controlled trials.

Subhani and colleagues found that those who received exenatide in one of the randomized controlled trials did not have reduced alcohol consumption in the past 30 days after 24 weeks of treatment vs. those who received placebo.

However, exenatide had a positive effect in people with obesity — defined as a BMI of over 30 kg/m² — who showed reductions in heavy drinking days (–23.6 percentage points; 95% CI, –44.4 to –2.7) and total alcohol consumed (–1,205 g; 95% CI, –2,206 to –204).

“While further mechanistic study is required to understand the differing effects of GLP-1 receptor agonists in people with normal weight and obesity, functional deficits in GLP-1 signaling in people with obesity may be relevant,” the researchers wrote.

In a secondary analysis of another randomized controlled trial, participants taking dulaglutide had 29% increased odds of reducing alcohol intake (relative effect size = 0.71; 95% CI, 0.52-0.97).

Meanwhile, the observational studies showed that those receiving GLP-1 receptor agonists had fewer alcohol-related health care events (HR =0.46; 95% CI, 0.24-0.86) and a substantial reduction in alcohol use compared with those receiving dipeptidyl peptidase-4.

Subhani and colleagues acknowledged several limitations across the examined studies, which included heterogeneity in patient populations, interventions and study designs, incomplete data on safety profiles and variations in reporting of adverse events.

Subhani underlined that the implications for clinicians “are significant.”

“Over a quarter of people in the U.S. and [United Kingdom] consume alcohol excessively, and obesity rates continue to rise,” she told Healio. “These findings could shift the approach to managing at-risk populations for liver disease in primary care settings. In the long term, integrating such interventions has the potential to reduce alcohol-related and liver disease-related morbidity and mortality, ultimately improving patient outcomes.”

Subhani added that GLP-1 receptor agonists “should only be used under medical supervision [and] are intended as adjuncts, not substitutes, for lifestyle interventions in managing harmful alcohol intake and obesity.”

“While real-world evidence has reported serious side effects, such as acute pancreatitis, data from large-scale research studies indicate that these medications are generally safe when used appropriately and for right indication,” she said.

References:

• Diabetes medication may be effective in helping people drink less alcohol.https://www.nottingham.ac.uk/news/diabetes-meds-may-help-people-drink-less-alcohol. Published Nov. 14, 2024. Accessed Nov. 21, 2024.
• Subhani M, et al. EClinicalMedicine. 2024;doi:10.1016/j.eclinm.2024.102920.