A nationwide Swedish cohort study of 227,866 individuals found that glucagon-like peptide-1 receptor agonists may be associated with a reduced risk of alcohol use disorder–related hospitalizations compared with periods when patients were not taking these medications.
In the study, published in JAMA Psychiatry, investigators analyzed data from 2006 to 2023, with a median follow-up of 8.8 years. The study population included 144,714 males (63.5%) and 83,154 females (36.5%), with a mean age of 40.0 years. Among 6,276 glucagon-like peptide (GLP)-1 receptor agonist users, the investigators identified 4,321 semaglutide users and 2,509 liraglutide users. The majority (81.8%) of them were born in Sweden, with 10.2% from other European countries and 8.1% from outside Europe.
At baseline, GLP-1 users showed distinct clinical characteristics. Among them, 31.1% had acute intoxication diagnoses, 34.0% had dependence syndrome, and 24.5% had harmful use diagnoses. Additionally, 27.3% had prior sickness absence, and 18.5% were on disability pension. At the end of the study period, 43.7% had type 2 diabetes, 50.6% had cardiovascular disease, and 18.7% had obesity.
The investigators employed a within-individual design using Cox regression models with fixed effects, where each patient served as their own control. The analysis adjusted for concurrent use of psychotropic medications, including antipsychotics, antidepressants, mood stabilizers, benzodiazepines, and ADHD medications.
The investigators found that semaglutide use was associated with a 36% reduced risk of alcohol use disorder (AUD) hospitalization (adjusted hazard ratio [HR] = 0.64, 95% confidence interval [CI] = 0.50–0.83), whereas liraglutide showed a 28% reduction (adjusted HR = 0.72, 95% CI = 0.57–0.92).
Throughout the study period, 133,210 individuals (58.5%) experienced AUD hospitalizations. Both semaglutide and liraglutide were associated with a reduced risk of substance use disorder hospitalizations (semaglutide: adjusted HR = 0.68, 95% CI = 0.54–0.85; liraglutide: adjusted HR = 0.78, 95% CI = 0.64–0.97) and somatic hospitalizations (semaglutide: adjusted HR = 0.78, 95% CI = 0.68–0.90; liraglutide: adjusted HR = 0.79, 95% CI = 0.69–0.91).
Traditional AUD medications showed different outcomes. The use of approved AUD medications demonstrated modest risk reduction for hospitalizations (adjusted HR = 0.98, 95% CI = 0.96–1.00). Among the 75,454 AUD medication users, naltrexone specifically was associated with reduced risk (AUD: adjusted HR = 0.86, 95% CI = 0.83–0.89).
The study utilized comprehensive Swedish national registries, including the National Patient Registry, Microdata for Analysis of Social Insurance register, and the National Prescribed Drug Register. Individual drug use periods were constructed using the PRE2DUP method.
The observational nature of the study precluded determination of causality. The findings suggested that randomized clinical trials may be warranted to further investigate the potential therapeutic benefits of GLP-1 receptor agonists in treating AUD.
Full disclosures can be found in the study.
