Semaglutide for Treatment of Alcohol Use Disorder

Background: With a lifetime prevalence nearing 30%, alcohol use disorder (AUD) is the most common substance use disorder in the United States. It is characterized by a decreased ability to regulate alcohol consumption, despite negative health and social impacts. Despite the morbidity and mortality associated with AUD, less than 2% of patients with AUD receive one of the three FDA-approved AUD pharmacotherapies (disulfiram, naltrexone, and acamprosate). Recent preclinical findings suggest that glucagon-like peptide 1 (GLP-1) agonism may reduce alcohol consumption. The present study employed a retrospective chart review to assess the effectiveness of the GLP-1 analogue semaglutide at improving AUD symptoms in patients with AUD. Methods: A retrospective chart review was conducted to evaluate intake and follow-up appointments of patients seen in an obesity medicine and bariatric surgery clinic. Patients were selected if they were prescribed semaglutide for the treatment of diabetes or obesity. All patients included in the study had a baseline consistent with AUD based on scores from the Alcohol Use Disorders Identification Test (AUDIT). AUDIT scores were routinely collected at subsequent visits. The primary endpoint was change in AUDIT score from intake. Relevant patient characteristics were also recorded, including body mass index (BMI), weight, sex, diabetes mellitus, and semaglutide dose. Results: We identified six patients meeting criteria for AUD who subsequently received semaglutide (age 43.5 ± 12.3 years, five female, mean intake AUDIT = 14.0 ± 3.9, mean follow-up AUDIT = 4.5 zt 2.0). Semaglutide doses averaged 0.5 mg (0.25-1.0 mg). All 6 patients exhibited a significant decrease in AUDIT score (mean decrease 9.5 ± 2.7, p < 0.001 by paired t test). At follow-up, all six patients exhibited AUDIT scores consistent with remission from AUD. Conclusions: Semaglutide may represent a novel treatment option for those with AUD and warrants further clinical investigation.