The glucagon-like peptide 1 (GLP-1) receptor agonist semaglutide has been approved by the US Food and Drug Administration (FDA) as a treatment for type 2 diabetes (Ozempic) and obesity (Wegovy).
However, this compound also promises to address some of the neural pathways involved in our reward system. At least as far as rodents and monkeys are concerned, drugs like semaglutide reduce the consumption of food, alcohol, nicotine, cocaine and methamphetamines.
In November 2023, we saw the first case series of six patients with a dual diagnosis of obesity and alcohol-use disorder. All patients had been prescribed semaglutide for weight management and, as part of their workup, had undergone an Alcohol Use Disorder Identification Test (AUDIT; score > 8 considered positive).
The mean AUDIT score at baseline in this small group of patients was 14, which fell dramatically to 4.5 on average after semaglutide treatment. This mean 9.5-point decrease in AUDIT scores with semaglutide was statistically significant (P < .001). However, these were only six patients, a tiny number, and several biases may have affected the results. Currently, two randomized controlled studies are on the way, with results expected in 2024. More significant patient numbers may provide us with a better understanding of the pros and cons of using semaglutide in the management of addictive behaviour.
The doses needed to achieve the reduced test scores were lower than those approved for weight management purposes. Could this mean that there are fewer chances for side effects? Only time will tell. As in so many areas of medical research, you should be careful when extrapolating a potentially successful treatment to a broader group of people. There was no long-term follow-up in the first instance, although reduced AUDIT scores were present after weeks to months.
Furthermore, even the most beautiful rose can have nasty thorns. All drugs have side effects which range from not uncommon and benign to rare and potentially life-threatening. The latter, in the case of semaglutide, include pancreatitis and allergic reactions. The drug is contraindicated in patients with a history of gallbladder disease, pancreatitis, medullary thyroid cancer and other rare cancers.
In the future, semaglutide might be a more promising tool for healthcare providers and patients alike.
References
Jerlhag, E. (2023). The therapeutic potential of glucagon-like peptide-1 for persons with addictions based on findings from preclinical and clinical studies. Frontiers in Pharmacology, 14, 1063033. https://doi.org/10.3389/fphar.2023.1063033
https://www.psychiatrist.com/jcp/decreased-alcohol-use-disorder-symptoms-with-semaglutide-for-weight-loss-a-case-series/
https://www.thelancet.com/journals/ebiom/article/PIIS2352-3964(23)00207-4/fulltext
