June 13, 2023 – Could the category of recent weight-loss drugs, including semaglutide – Approved as Ozempic to treat type 2 diabetes and Wegovy to treat obesity – also to curb addictions and compulsive behavior?
As demand for semaglutide for weight reduction increased following the FDA approval of Wegovy in June 2021, personal reports also emerged of unexpected additional advantages for the category of medication often called GLP-1, which inhibits a natural hormone called Glucagon-like peptide-1 that helps you’re feeling full.
Some patients taking these drugs for type 2 diabetes or weight reduction also lost interest in addictive and compulsive behaviors equivalent to drinking alcohol, smoking, shopping, nail biting and skin picking, in response to articles in The New York TimesAnd The Atlantic, amongst others. At the moment, the reports are merely anecdotal, subjective and never yet clinically verified. However, there’s also some initial research that supports these observations.
Current and upcoming studies
“I hope that GLP-1 analogues can be used in the future against [alcohol use disorder]but before this can happen, several GLP-1 studies must [are needed to] demonstrate an effect on alcohol consumption,” said Anders Fink-Jensen, MD, lead author of a recent randomized controlled trial of 127 patients with alcohol use disorder (AUD).
His study involved patients who received exenatide, the first-generation GLP-1 agonist approved for type 2 diabetes, for 26 weeks. However, this did not reduce the number of days of heavy drinking compared to a placebo.
However, in analyses conducted after the study was completed, the number of days of heavy drinking and total alcohol intake were significantly lower in the subgroup of patients with AUD and obesity (as determined by a body mass index (BMI) of over 30).
Participants were also shown pictures of alcohol or neutral people during functional magnetic resonance imaging (MRI). In those who received exenatide instead of a placebo, the activation of the reward centers in the brain was significantly lower when they were shown the pictures of alcohol.
This shows that “something is happening in the brain and the activation of the reward center is hindered by the GLP-1 compound,” said Fink-Jensen, a clinical psychologist at the Copenhagen Psychiatric Center in Denmark.
“Of course, if patients with AUD already meet the criteria for semaglutide (or other GLP-1 analogues) by having type 2 diabetes and/or a BMI over 30, they can use the drug immediately,” he said.
His team is also beginning a trial in patients with AUD and a BMI of 30 or higher to examine the effects of semaglutide up to 2.4 milligrams weekly on alcohol consumption, the maximum dose of semaglutide approved for obesity in the United States.
“Given the effectiveness of exenatide and semaglutide,” says Fink-Jensen, “we expect semaglutide to result in a greater reduction in alcohol consumption” than exenatide.
Animal studies have also shown that GLP-1 agonists suppress alcohol-induced reward, alcohol consumption, motivation to drink, alcohol craving and alcohol relapse, in response to researcher Dr. Elisabet Jerlhag Holm.
These drugs also suppress the reward, uptake and motivation to make use of other addictive substances equivalent to cocaine, amphetamine, nicotine and a few opioids, said Jerlhag Holm, a professor on the Institute of Pharmacology on the University of Gothenburg in Sweden.
Your group recently Published results a study in rats that provides evidence to help explain anecdotal reports of patients with obesity treated with semaglutide claiming they also reduced their alcohol consumption. In the study, semaglutide reduced both alcohol consumption (and relapse drinking) and body weight in rats of both sexes.
“Future research should investigate the possibility that semaglutide reduces alcohol consumption in patients with AUD, particularly in overweight patients,” said Jerlhag Holm.
“AUD is a … disorder [involving various components]and one medication is most likely not helpful for all AUD patients,” she said, “and therefore an arsenal of different medications is beneficial in treating AUD patients.”
Janice J. Hwang, MD, MHS, agreed.
“There are numerous reports from patients (and in the news) that this class of drugs affects drug cravings and could lead to addictive behavior,” she said.
Still, “in my opinion, it's far too early to say” whether these drugs may very well be approved to treat addiction patients without more solid data from clinical trials, said Hwang, associate professor of drugs and chief of the division of endocrinology and metabolism on the University of North Carolina at Chapel Hill.
Meanwhile, one other research group on the University of North Carolina at Chapel Hill, led by psychiatrist Christian Hendershot, PhD, is conducting a clinical study in 48 individuals with AUD who’re also smokers.
The aim is to seek out out whether patients who receive semaglutide injections in increasingly higher doses over a period of nine weeks drink less alcohol and smoke lower than patients who receive a placebo injection. The results are expected in October.