Semaglutide for alcohol use disorder: two small trials, both with fewer drinks per drinking day

Two small randomised trials have now tested semaglutide in adults with alcohol use disorder. The first, in 48 people, found that low-dose weekly semaglutide cut the amount of alcohol they drank in a laboratory test [1]. The second, in 50 people, missed its main craving target but still found fewer heavy drinking days [2]. Both found fewer drinks per drinking day [1][2].

Why this study matters

Semaglutide is best known for weight loss and diabetes. The first trial's authors note that preclinical, observational and pharmacoepidemiology evidence suggests drugs of this class may reduce alcohol intake, and that randomised trials were needed to find out whether the finding holds up in people [1]. These two phase 2 trials test it directly.

A phase 2 trial is an early test of whether a drug shows a signal. It is not designed to prove a treatment works.

What they did

The two trials were not identical, and the differences matter.

What they found

In the first trial, semaglutide reduced the grams of alcohol consumed in the laboratory task (β −0.48, 95% CI −0.85 to −0.11, P = .01) and peak breath alcohol concentration (β −0.46, 95% CI −0.87 to −0.06, P = .03) [1]. It did not change average drinks per calendar day or the number of drinking days [1]. It did reduce drinks per drinking day (β −0.41, P = .04) and weekly craving (β −0.39, P = .01) [1].

In the second trial, semaglutide did not significantly reduce laboratory craving, the primary outcome, or drinks per day [2]. It did reduce heavy drinking days (b −0.580, 95% CI −1.012 to −0.148) and drinks per drinking day (b −1.177, 95% CI −2.307 to −0.047) [2]. Naturalistic craving, alcohol-related consequences and cannabis use days also fell [2]. More participants on semaglutide than on placebo dropped by one or more risk drinking levels [2].

Put side by side, the two trials agree on drinks per drinking day and on craving measured outside the laboratory. They disagree on the laboratory measures, which is what you would expect from small trials with different designs.

How to read a laboratory drinking test

Both trials used laboratory tasks as part of their main measures. In the first, participants had a chance to drink alcohol in a controlled setting before and after treatment, and the researchers measured grams consumed and peak breath alcohol concentration [1]. In the second, the primary measure was craving after exposure to alcohol cues in the laboratory, at week 6 [2]. A laboratory test is tidy and repeatable, and it is not the same as drinking at home. That is why both trials also recorded drinking and craving between visits, and why the results outside the laboratory matter at least as much.

Caveats

• Small. Forty-eight and 50 people are enough to see a signal and not enough to size an effect precisely [1][2].
• Short. Nine and eight weeks say nothing about drinking over months or years.
• Missed targets. The second trial did not meet its primary end point [2], and the first found no change in average drinks per calendar day or in drinking days [1].
• Many outcomes. Both trials tested a long list of outcomes. Some significant results among many can arise by chance, which is one reason larger trials are needed.
• Different populations. The first enrolled people not seeking treatment, and 71% were female [1]. The second enrolled people seeking treatment [2]. A signal in one group does not carry over automatically to the other.
• Funding. Neither abstract states who paid for the trial. The disclosure statements list consulting, advisory and research ties to drug companies for some authors [1][2].

What it means in practice

Taken together, the trials give a reason to run larger ones and no basis for treating semaglutide as a treatment for alcohol use disorder. The authors of the first trial conclude that the findings justify larger clinical trials [1], and the second trial's authors say continued development for this condition is warranted [2].

Anyone worried about their own drinking has established options through a GP or an addiction service. Semaglutide is a prescription medicine, and that decision belongs with a prescriber. For the wider picture on the drug, see our semaglutide guide and the SELECT trial breakdown.

What this means

We read these two trials as a credible early signal. A drug class built for weight and blood sugar appears to reduce how much people drink on a drinking day, and the direction is the same in two separate groups. We are confident that the question deserves larger trials, and unsure how big or lasting any effect is. Take from it that the idea is worth testing properly. Do not take from it that semaglutide is a treatment for alcohol use disorder.

Educational content only — not medical advice. Many peptides discussed on HPR are not approved for human use. Talk to a qualified clinician before making any decision about your health.