Incretin-Based Therapies and Post-Bariatric Surgery Alcohol Use Disorder

Area of Science:

• Medical research
• Pharmacology
• Public health

Background:

• Bariatric surgery patients face increased risk of alcohol use disorder (AUD).
• Incretin-based therapies (IBTs) may influence reward pathways beyond weight loss.

Purpose of the Study:

• To determine if IBTs post-bariatric surgery lower the risk of new-onset AUD.
• To assess if IBTs reduce the initiation of medications for AUD (MAUDs) compared to non-IBT antiobesity medications (AOMs).

Main Methods:

• Retrospective cohort study of 15,382 adults post-bariatric surgery receiving AOMs.
• Propensity score matching (1:1) to balance baseline characteristics.
• Comparison of IBTs (semaglutide, liraglutide, tirzepatide) versus non-IBT AOMs.

Main Results:

• IBT use was linked to a lower incidence of AUD (2.4 vs 5.2 per 1000 person-years) and reduced AUD hazard (HR, 0.45).
• IBT use was associated with lower incidence of MAUD initiation (15.2 vs 25.6 per 1000 person-years) and reduced hazard (HR, 0.59).
• Findings were consistent across sensitivity analyses.

Conclusions:

• IBTs were associated with a 55% lower risk of new-onset AUD and a 41% lower risk of MAUD initiation post-bariatric surgery.
• These results suggest potential neurobehavioral advantages of IBTs in this population.
• Further prospective studies are needed to confirm these findings and assess long-term outcomes.