Will new trial prove ‘miracle’ weight loss drug Wegovy can curb a craving for alcohol?

It is the type 2 diabetes and weight loss medication that has taken the world by storm. But studies now suggest that semaglutide, better known by the brands Ozempic and Wegovy, could also help people addicted to alcohol.

Around 1.7 million adults drink at levels that are likely to negatively affect their health, according to the Health Survey for England 2021.

Anecdotal reports first emerged last summer that the obesity ‘wonder’ drug, taken as a daily pill or injection, was also curbing the taste for alcohol among those prescribed it for weight loss.

The first clinical trials in humans are now being carried out after these beneficial effects were confirmed in animal studies.

Researchers at Oklahoma State University (USA) have launched the Semaglutide Therapy for Alcohol Reduction (STAR) study, in which 80 people who abuse alcohol or are alcohol dependent will receive weekly injections of semaglutide or placebo for 12 weeks.

The semaglutide group will start at a dose of 0.25 mg per week for four weeks, eventually increasing to 1 mg per week, the same dosing schedule used when starting semaglutide for type 2 diabetes.

The study will measure changes in alcohol consumption as well as changes in brain activity using scans such as functional magnetic resonance imaging (fMRI).

Kyle Simmons, a professor of pharmacology and physiology who is leading the trial, told Good Health: ‘Semaglutide appears to modulate activity in the brain’s reward circuits, making food and alcohol less rewarding.

‘In other words, with semaglutide on board, the food or alcohol in front of you is not as ‘hot’ a stimulus to your brain as it would otherwise be.

“We don’t yet know whether semaglutide is safe and effective for treating alcohol use disorder, but data from studies in rodents and monkeys suggest it will be and anecdotal evidence in humans suggests it might be.”

While trial results may not be known until 2025 at the earliest, animal research data has generated much interest in the drug’s potential.

A study by scientists at the University of Gothenburg in Sweden, published in the journal eBioMedicine in June, found that semaglutide reduced alcohol intake in rats by 60 percent.

The researchers attached a fluorescent molecule to semaglutide to track where it went in the rats’ bodies and found that it bound to the nucleus accumbens, a region of the brain involved in the reward system, although it is not known exactly how it has an effect. Of course, said study co-author Elisabet Jerlhag Holm, a professor of pharmacology.

“Semaglutide blocks the rewarding experience of alcohol,” he told Good Health.

“In (the) nucleus accumbens we know that it binds, but we don’t know the mechanisms yet.” One theory is that it enhances the transmission of GABA (gamma-aminobutyric acid), a chemical messenger involved in reward.

Another study, conducted by the University of Copenhagen in Denmark, presented at the Alcoholism Research Society conference in June, looked at how much alcohol monkeys consumed when it was made available to them (along with water) for four hours a day.

Half of the monkeys were then given semaglutide and the other half a placebo, before they were allowed access to alcohol again.

This time, the semaglutide group consumed 40 percent less alcohol than the placebo group.

Researchers at Oklahoma State University (USA) have launched the Semaglutide Therapy for Alcohol Reduction (STAR) study.

“This is a huge effect,” says Professor Simmons. In fact, Professor Anders Fink-Jensen, a psychiatrist who led the study at the University of Copenhagen, said semaglutide was up to 20 percent more effective in curbing alcohol consumption than other drugs in the same class they had previously tried. .

The 2021 Health Survey for England found that one in five adults (ten million people) drink above the recommended weekly limit of 14 units, with 1.7 million of them drinking between 35 and 50 units per week.

So could semaglutide help “social” drinkers reduce their consumption, as well as those dependent on alcohol?

“The answer depends a little on what we find in trials, but there is potential to help both patients who want to stop drinking completely and those who simply want to drink less,” says Professor Simmons.

“A potentially interesting scenario is that it could be used to help maintain sobriety during the first six months or years of overall treatment for alcohol use disorder, when patients are at higher risk of relapse and while they gain skills through psychotherapy and making other life changes.’ But there may be difficulties: Because semaglutide appears to work by altering the way the brain experiences reward, there are concerns that it may also affect people’s mood and cause depression in those susceptible to the condition.

In July, the Medicines and Healthcare products Regulatory Agency (MHRA) launched a review of the class of medicines to which semaglutide belongs after receiving five reports of “suicidal and self-harm behaviour” through its Yellow Card monitoring system. the safety of medications and their possible side effects. -effects.

This review is ongoing. The MHRA told Good Health: “We are considering all available evidence and will communicate any further advice to patients and healthcare professionals as appropriate.”

Professor Simmons adds: “If the drug alters the activity of the brain’s reward circuits, we need to ensure that it does not promote anhedonia, a general loss of interest in pleasure.”

‘It would not be ideal if patients had to choose between reducing the harms associated with excessive alcohol consumption and losing some of their ability to enjoy the pleasures of life in general, such as social interaction or sex, for example.

‘Anhedonia also poses a potential risk for patients who may have a history of depression but whose disease is currently in remission.

“We want to be sure that treatment for alcohol use disorder does not cause anhedonia that increases the likelihood of a relapse into depression.”

Semaglutide pen injection called ‘ozempic’, is a diabetes medicine that improves blood sugar

Matt Field, professor of psychology at the University of Sheffield, adds: “Semaglutide may reduce the likelihood of you binge drinking after consuming one or two drinks.”

“But there are many examples of anti-addiction drugs that seemed to work in animals but didn’t work at all in humans for one reason or another.”

Currently, medicines approved to treat alcohol dependence in the UK include acamprosate calcium (trade name Campral); disulfiram (Antabuse); and nalmefene.

Acamprosate works by affecting GABA levels, which is thought to influence cravings.

The NHS says it is used to help prevent a relapse in people who have successfully stopped drinking and is usually offered in combination with counselling.

Disulfiram, meanwhile, is prescribed to people who are trying to stop drinking but there is concern that they will relapse; It works as a deterrent by causing unpleasant physical reactions, such as nausea and vomiting, if the person drinks.

Nalmefene blocks opioid receptors in the brain to reduce cravings, prevent relapse, or limit how much a person drinks.

Another, more controversial option is to treat patients with ketamine, the “party drug.”

Could semaglutide help “social” drinkers reduce their consumption, as well as those who are alcohol dependent?

Last year, researchers at the University of Exeter published the results of a study involving 96 people that showed that a combination of cognitive behavioral therapy (a talk therapy) and low doses of ketamine helped drinkers stay completely sober for 162 of 180 days at the six-month follow-up. period, representing 87 percent abstinence, the American Journal of Psychiatry reported.

Research leader Celia Morgan, a professor of psychopharmacology, told Good Health: “We believe that ketamine facilitates psychological therapy by affecting the neuroplasticity of the brain (meaning it is able to learn more easily) and by giving people a new perspective on their lives. problems through unique subjective effects.’

Professor Morgan’s team has now been awarded £2.4 million from the Medical Research Council, the National Institute for Health and Care Research and a private company to carry out a larger trial across seven NHS sites.

Dr Emily Finch, chair of the Faculty of Addictions at the Royal College of Psychiatrists, says new drug treatments for alcohol addiction will “always be welcomed” but must undergo “extensive research and rigorous clinical trials”.