As blogged previously, many people taking GLP1 medication report a decreased desire/consumption of alcohol, but we’ve been lacking clinical trial data to teach us more about this.
A randomized controlled clinical trial of semaglutide 2.4mg weekly (Wegovy) is the first to show benefit to reduce alcohol consumption in people with alcohol use disorder and obesity.
This was a small clinical trial of 108 people (about half men and half women, average age 52, baseline BMI about 34.5 kg/m2) in Denmark seeking treatment for alcohol use disorder (a disorder characterized by loss of control of alcohol consumption and compulsive use), and they had to have a minimum of 6 heavy drinking days (using 40% vodka to give context, this is equivalent to at least 6.4 oz/day of 40% vodka for men or 5oz/day for women) per month at baseline. They were randomized to receive Wegovy (semaglutide) titrated to 2.4mg weekly (or max tolerated dose) or placebo, alongside up to 10 cognitive behavioural therapy (CBT) sessions.
At baseline, participants had an average 17.2 heavy drinking days per month, with an overall alcohol intake of 2201g of alcohol (equivalent to about 236 oz of 40% vodka) per month. At 26 weeks, people in the semaglutide group had a 41% reduction in number of heavy drinking days vs 26% reduction with placebo. Mean total alcohol consumption per month decreased by 1550g (166 oz of vodka) with semaglutide vs 1026g (110 oz of vodka) with placebo, and average number of drinks per day decreased by 3.5 units with semaglutide vs 2.1 units with placebo. Weight loss was 11.4% in the semaglutide group vs 2% with placebo.
These results are exciting for people with alcohol use disorder, but there are a number of caveats to consider. Similar to what we see for effect of GLP1 medication for weight loss, there was wide variability in response, with some people showing little to no reduction in drinking, and others a huge benefit. This study was done with lots of CBT support, which doesn’t reflect the real world in most cases. Many people with alcohol use disorder do not have obesity, and treatment with Wegovy would be limited to those with elevated weight in whom weight loss would be beneficial; alternatively, lower doses of medication could be studied to see if there could be benefit to reduce drinking without unwanted weight loss in those people. This study was done in Denmark in mostly white people, so studies are needed in diverse populations. The study was small and short, and follow up data would also be important to know if semaglutide needs to be continued to have the continued reduction in drinking – based on what we know about the need to continue treatment to continue managing weight, I suspect that treatment would likely need to continue here as well. Also, note that people in this study were actively seeking help for their drinking, so we don’t know if people not looking for help would spontaneously reduce their drinking with semaglutide.
There are now many clinical trial registrations for other GLP1-based medications, as well as other hormone-based obesity medications under development like amylin agonists, for alcohol use disorder. It will be very exciting to see how this field unfolds!
Disclaimer: I am/have been an investigator in clinical trials of semaglutide (Ozempic and Wegovy). I receive honoraria as a continuing medical education speaker and consultant from the makers of semaglutide (Novo Nordisk).
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