Real-World Alcohol Use Disorder Outcomes in Patients With Concurrent Metabolic Dysfunction: GLP-1 Receptor Agonists...

Area of Science:

• Metabolic dysfunction and alcohol use disorder research
• Pharmacological interventions for addiction and metabolic diseases

Background:

• Metabolic dysfunction (MetD) and alcohol use disorder (AUD) often co-occur, increasing the risk of liver disease.
• Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are effective for MetD (e.g., type 2 diabetes mellitus, obesity).
• Emerging evidence suggests GLP-1RAs may help reduce addictive behaviors in AUD.

Purpose of the Study:

• To compare the effectiveness of GLP-1RA therapy versus FDA-approved AUD pharmacotherapies.
• To evaluate outcomes in patients with both MetD and AUD.
• To assess relapse rates, metabolic improvements, and liver outcomes.

Main Methods:

• Retrospective cohort study at Stanford Health Care (2017-2025).
• Included patients with concurrent AUD and MetD (obesity and/or T2DM).
• Compared GLP-1RA (semaglutide, tirzepatide) use (≥6 months) with naltrexone, acamprosate, or disulfiram using propensity score matching.

Main Results:

• GLP-1RA group had higher baseline BMI and T2DM prevalence.
• GLP-1RA therapy was associated with significantly lower 1-year AUD relapse rates (IRR 0.55).
• GLP-1RA use led to greater BMI reduction and HbA1c improvement compared to AUD pharmacotherapies.

Conclusions:

• GLP-1RAs represent a potential therapeutic option for individuals with coexisting MetD and AUD.
• GLP-1RA therapy demonstrated superior outcomes in reducing AUD relapse and improving metabolic parameters.
• Observed trends suggest potential liver benefits, warranting further investigation in prospective studies.