Newer GLP-1 medications may reduce alcohol-related hospitalization risk

Use of newer GLP-1 receptor agonists (semaglutide or tirzepatide) for obesity or diabetes by people with alcohol-use disorder was associated with a reduction in alcohol-related admissions to hospital, finds a study published online in the open access journal BMJ Open.

The findings suggest a potential role for the drugs semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro) in the treatment of alcohol-use disorder.

While GLP-1 receptor agonists are used primarily for the treatment of type 2 diabetes and obesity, there have been reports of reduced alcohol consumption among patients taking the drugs, prompting the authors to investigate the potential impact on alcohol-related hospitalizations among adults with alcohol-use disorder.

The study compared alcohol-related hospitalizations in 40 703 adults with alcohol-use disorder and type 2 diabetes or obesity who started a newer GLP-1 receptor agonist (semaglutide or tirzepatide) or a comparator drug between 1 January 2018 and 31 December 2024. Participants were split across four trials involving clinically distinct populations – the anti-diabetic medication (ADM) trial, anti-obesity medication (AOM) trial, medications for alcohol use disorder with type 2 diabetes (MAUD- T2D) trial, and medications for alcohol-use disorder with obesity (MAUD-obesity) trial.

Compared to participants taking an active comparator drug, those taking GLP-1 receptor agonists had a lower risk of alcohol-related admission to hospital during all four trials.

Use of GLP-1 receptor agonists was associated with a 26% lower risk of alcohol-related hospital admission than other diabetes medicines during the diabetic medication (ADM) trial, and a 32% lower risk of alcohol-related hospital admission than other obesity medicines during the anti-obesity medication (AOM) trial.

In the MAUD trials, the active comparators were drugs for alcohol-use disorder including acamprosate, disulfiram and naltrexone. Compared with taking drugs for alcohol-use disorder, use of GLP-1 receptor agonists by adults with type 2 diabetes was associated with a 63% lower risk of alcohol-related admission to hospital during the trial, and for adults with obesity use of GLP-1 receptor agonists was associated a 65% lower risk of alcohol-related hospitalizations.

The authors acknowledge several limitations to their study. Most importantly, alcohol-use disorder is under-captured due in part to stigmatisation, and when documented, it may also be recorded variably with lower reporting in areas of high social deprivation. Alcohol-related outcomes may have been under captured as they were defined using diagnosis codes and laboratory testing for alcohol exposure, and the study captured hospitalizations from treatment initiation to discontinuation in a trial environment, so treatment effects in an average clinical setting may differ.

Finally, there may have been some confounding in relation to socioeconomic status, underlying clinical stability or alcohol-use disorder severity, and healthcare engagement, as newer GLP-1 receptor agonists are higher-cost therapies and patients with access to these medications may differ from comparator groups.

The risk of residual confounding was greatest in the MAUD trials, as reflected by the reduced risk of non-alcohol-related hospitalizations with use of GLP-1 receptor agonists. The authors say the results of the MAUD trials should be interpreted with greater caution as there were also high rates of treatment discontinuation increasing the potential for bias.

Nevertheless, the authors conclude, "Initiation of newer GLP-1 receptor agonists among patients with alcohol-use disorder was associated with a lower observed risk of alcohol-related hospitalization, with similar associations across populations with type 2 diabetes and obesity.

"These findings may suggest a potential role for GLP-1 receptor agonists in the context of alcohol-use disorder."