Lancet
Weight-loss drug cuts heavy drinking in randomized trial
Clinical takeaway: Consider emerging evidence for GLP-1 receptor agonists as adjunctive therapy in patients with alcohol use disorder (AUD) and obesity, as semaglutide significantly reduced heavy drinking and total alcohol intake over 26 weeks.
Effective medications for alcohol use disorder remain limited; a widely used obesity drug could open a new treatment pathway for a high-risk population.
A randomized, double-blind trial of 108 treatment-seeking adults with moderate-to-severe AUD and comorbid obesity (BMI ≥30 kg/m²) found that once-weekly semaglutide (2.4 mg) significantly reduced heavy drinking compared with placebo over 26 weeks. Heavy drinking days fell by 41.1 percentage points in the semaglutide group vs. 26.4 points with placebo, a between-group difference of −13.7 points (p=0.0015).
Participants receiving semaglutide also showed greater reductions in total alcohol consumption (−1550 vs −1026 g per 30 days; difference −467.5 g), drinks per drinking day (−3.5 vs −2.1), and alcohol craving (difference −3.1 points). Improvements extended to WHO risk drinking levels (difference −0.52), with a number needed to treat of 4.3—lower than that reported for currently approved AUD medications.
Metabolic benefits were substantial, including –11.2 kg weight loss vs. –2.2 kg with placebo (difference −9.0 kg), along with favorable changes in liver biomarkers and blood pressure. Gastrointestinal adverse events were common but generally mild to moderate (eg, nausea in 57% vs. 7%) and transient.
“Very few medications are currently approved for alcohol use disorder…a new option that is more accessible and more effective could be a gamechanger for closing the treatment gap,” said NIAAA Director George Koob, PhD, a study co-author.
NIDA Director Nora Volkow, MD, added, “We’re beginning to see some of that potential for GLP-1s to treat drug addiction turn into reality…this is nonetheless very encouraging.”
Authors noted the study was limited to patients with obesity and lacked long-term follow-up, but concluded that semaglutide demonstrates “robust therapeutic effects,” supporting further investigation as a novel treatment option for AUD.
Source: Klausen MK, et al. (2026, May 2). Lancet. Once-weekly semaglutide versus placebo in patients with alcohol use disorder and comorbid obesity: a randomised, double-blind, placebo-controlled trial