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

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

According to The Health Survey for England 2021, around 1.7 million adults are drinking at levels likely to negatively impact their health.

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

Now the first human clinical trials are underway after these beneficial effects were confirmed in animal studies.

Researchers from Oklahoma State University in the US have designed the Semaglutide Therapy for Alcohol Reduction (STAR) trial, in which 80 people who abuse or are dependent on alcohol will receive weekly semaglutide or placebo injections 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, professor of pharmacology and physiology leading the trial, told Good Health: ‘Semaglutide appears to modulate activity in the brain’s reward circuitry, making food and alcohol less rewarding.

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

‘We do not yet know whether semaglutide is safe and effective for the treatment of alcohol use disorders, but data from studies in rodents and monkeys suggest that it will be the case and anecdotal evidence in humans suggests that this may be the case.’

Although the results of the trial won’t be known until 2025 at the earliest, data from animal research has generated a lot of interest in the drug’s potential.

A study conducted 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 the semaglutide to track where it ended up in the rats’ bodies and found that it bound to the nucleus accumbens, a part of the brain involved in the reward system – although it’s not exactly clear is how it has an effect. clear, said co-author Elisabet Jerlhag Holm, professor of pharmacology.

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

‘We know that it binds in (the) nucleus accumbens, but we do not yet know the mechanisms.’ 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 and presented at the Research Society on Alcoholism conference in June, looked at the amount of alcohol monkeys consumed when it was made available to them – along with water – for four hours per day.

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

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

“That’s a huge effect,” notes Professor Simmons. In fact, Professor Anders Fink-Jensen, a psychiatrist who led the study from the University of Copenhagen, said that semaglutide was up to 20 percent more effective at reducing alcohol consumption than other drugs from the same class that they had previously tried.

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

So could semaglutide help ‘social’ drinkers cut down, as well as alcohol addicts?

‘The answer depends a bit on what we find in the studies, but the potential is there 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 support sobriety during the first six months or first year of overall alcohol dependence treatment, when patients are at greater risk of relapse, and as they acquire skills through of psychotherapy and therapy. making other life changes.” But there can be pitfalls. Because semaglutide appears to work by changing the way the brain experiences rewards, there are concerns that it may also affect people’s mood and cause depression in people prone 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 drug safety monitoring system and possible side effects. -Effects.

This review is ongoing. The MHRA told Good Health: ‘We are considering all available evidence and will pass on further advice to patients and healthcare professionals as appropriate.’

Professor Simmons adds: ‘If the drug changes the activity of the brain’s reward circuitry, 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 harm associated with heavy drinking and losing some of their ability to enjoy life’s pleasures more generally, such as social interaction or sex.

‘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 doesn’t produce anhedonia that makes a relapse into depression more likely.”

Matt Field, professor of psychology at the University of Sheffield, added: ‘Semaglutide can reduce the chance of you drinking excessively after having one or two drinks.

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

Currently, medicines approved for the treatment of alcohol dependence in Britain include acamprosate calcium (brand name Campral); disulfiram (Antabuse); and nalmefene.

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

The NHS says it is used to help prevent 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 are concerned about a relapse; it acts as a deterrent by causing unpleasant physical reactions, such as nausea and vomiting, when the person drinks.

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

Another, more controversial option is treating patients with the ‘party drug’ ketamine.

Last year, researchers from the University of Exeter published the results of a study of 96 people showing that a combination of cognitive behavioral therapy – a talking therapy – and low doses of ketamine helped drinkers stay completely sober for 162 out of 180 days in six months long-term follow-up. period, which equates to 87 percent abstinence, according to the American Journal of Psychiatry.

Study leader Celia Morgan, professor of psychopharmacology, told Good Health: ‘We think ketamine facilitates psychological therapy by both affecting neuroplasticity in the brain – meaning it makes learning easier – and by giving people a new perspective on their lives . problems due to the unique subjective effects.’

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

Dr. Emily Finch, chair of the Addiction Faculty at the Royal College of Psychiatrists, says new pharmacological treatments for alcohol addiction ‘will always be welcome’ but must undergo ‘extensive research and rigorous clinical trials’.