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

This is the type 2 diabetes and weight loss drug that has taken the world by storm. But now research suggests that semaglutide (better known by its brand names Ozempic and Wegoby) may also help people with alcohol dependence.

According to the 2021 Health Survey for England, around 1.7 million adults drink alcohol at levels that could be harmful to their health.

Anecdotal reports first surfaced last summer that this “magic bullet” for obesity, taken as a daily pill or injection, also suppressed alcohol preferences in patients prescribed it for weight loss.

After these beneficial effects were confirmed in animal studies, the first human clinical trials are currently underway.

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

The semaglutide group will start at a dose of 0.25 mg per week for 4 weeks, eventually increasing to 1 mg per week. This is the same dosing schedule used when starting semaglutide for type 2 diabetes.

The study uses scans such as functional magnetic resonance imaging (fMRI) to measure changes in alcohol intake and changes in brain activity.

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

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

“While we do not yet know whether semaglutide is safe and effective in treating alcohol use disorder, data from studies in rodents and monkeys suggest it is safe, and anecdotal evidence in humans suggests that possibility.”

Although the results of the clinical trials may not be known until 2025 at the earliest, data from animal studies has generated a lot of interest in the drug’s potential.

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

The researchers attached fluorescent molecules to semaglutide to track where it entered the rats’ bodies and found that semaglutide bound to the nucleus accumbens, an area of ​​the brain involved in the reward system. Elisabeth Jerhag-Holm, co-author of the study and professor of pharmacology, said.

“Semaglutide interferes with the rewarding experience of alcohol,” she told Good Health.

‘in [the] We know that the nucleus accumbens connects, but the mechanism is still unknown. ” One theory is that it enhances the transmission of GABA (gamma-aminobutyric acid), a chemical messenger involved in reward.

Another study, presented at the Alcoholism Research Society in June at the University of Copenhagen in Denmark, looked at how much alcohol monkeys would consume if they were given alcohol for four hours a day along with water. investigated.

Half of the monkeys were then given semaglutide and a placebo, and then given alcohol again.

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

“That’s a big effect,” Professor Simmons points out. In fact, Professor Anders Fink Jensen, a psychiatrist who led the study at the University of Copenhagen, said semaglutide was up to 20 per cent more effective at curbing alcohol intake than other drugs in the same class that he had previously tried. Ta.

The 2021 Health Survey for England found that one in five adults (10 million people) drink more than the recommended limit of 14 units per week, with 1.7 million of them drinking between 35 and 50 units per week. It turned out that there was.

So, can semaglutide help alcoholics as well as others reduce their “social” drinking?

“The answer depends somewhat on what the trials find, but it has the potential to help both patients who want to stop drinking completely and those who simply want to reduce their drinking,” Professor Simmons said.

“One potentially interesting scenario is during the first six months or year of overall treatment for alcohol use disorder, where the patient is at high risk of relapse and is learning skills through psychotherapy or psychotherapy. This means it could potentially be used to support sobriety for periods of time and make other life changes. But there may be a catch. Semaglutide changes the way the brain experiences rewards. There are concerns that semaglutide may affect people’s mood and cause depression in people who are more susceptible to the condition.

In July, the Medicines and Healthcare products Regulatory Agency (MHRA) suspended semaglutide after receiving five reports of “suicide and self-harm” through its yellow card system, which monitors the safety and potential side effects of medicines. A review of the drug class to which it belongs has begun. -effect.

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 added: “If a drug is altering the activity of the brain’s reward circuits, we need to ensure that it does not promote anhedonia, or a general loss of interest in pleasure.” Ta.

“Ideally, patients would have to choose between reducing the harm associated with heavy drinking or losing some of their ability to enjoy life’s pleasures more generally, such as social interaction and sex. Not the target.

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

“We want to make sure that treating alcohol use disorder does not cause anhedonia that increases the likelihood of relapse into depression.”

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

“But there are many examples of addiction drugs that seemed to work in animals that, for some reason, just didn’t work in humans.”

Medications currently approved in the UK to treat alcohol dependence include acamprosate calcium (trade name Campral). Disulfiram (Antabuse); and nalmefene.

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

The NHS says it is used to prevent relapse in people who have successfully stopped drinking and is usually offered in conjunction with counseling.

Disulfiram, on the other hand, is prescribed to people who are trying to stop drinking but are concerned about relapse. Drinking alcohol causes unpleasant physical reactions such as nausea and vomiting, which act as a deterrent.

Nalmefene blocks opioid receptors in the brain to reduce cravings, prevent relapse, and limit alcohol consumption.

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

Last year, researchers at the University of Exeter published the results of a study of 96 people, showing that a combination of cognitive behavioral therapy (conversation therapy) and low-dose ketamine significantly lowered the number of drinkers in 180 days after a six-month follow-up. It has been shown that it is possible to maintain complete sobriety for 162 days. Eighty-seven percent are abstinent, the American Journal of Psychiatry reported.

Study leader Celia Morgan, professor of psychopharmacology, told Good Health: Solve problems through unique subjective effects.

Professor Morgan’s team has now secured £2.4 million in funding from the Medical Research Council, the National Institute for Health and Care Excellence and private companies to carry out a large-scale clinical trial across seven NHS sites.

Dr Emily Finch, head of the addiction department at the Royal College of Psychiatrists, said new drug treatments for alcohol dependence were “always welcome” but needed to undergo “extensive research and rigorous clinical trials”. Ta.