Will new trial prove ‘miracle’ weight loss drug Vegovi can curb alcohol cravings?

It is a 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, may also help people addicted to alcohol.

Around 1.7 million adults drink at levels likely to adversely 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, also reduced the taste for alcohol in those prescribed it for weight loss.

Now the first clinical trials in humans are underway, after those beneficial effects were confirmed in animal studies.

Researchers at Oklahoma State University in the US set up the Semaglutide Therapy for Alcohol Reduction (STAR) study in which 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 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 circuitry, making food and alcohol less rewarding.

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

“We do not yet know whether semaglutide is safe and effective for treating alcohol use disorder, but data from rodent and monkey studies suggest that it will be, and anecdotal evidence in humans suggests that it may be.”

Although the results of the trial may not be known until 2025 at the earliest, the animal research data 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 semaglutide to track where it went in the rats’ bodies and found it bound to the nucleus accumbens, a region of the brain involved in the reward system, although it’s not clear exactly how it works there. , said study co-author Elizabeth Jerlag Holm, professor of pharmacology.

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

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

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

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

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

“It’s a huge effect,” notes Professor Simmons. Indeed, Professor Anders Fink-Jensen, a psychiatrist who led the study at the University of Copenhagen, said semaglutide was up to 20 percent more effective at curbing alcohol consumption than other drugs in 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 can semaglutide help “social” drinkers taper off as well as alcohol addicts?

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

“One potentially interesting scenario is that it could be used to support sobriety during the first six months or year of overall alcohol use disorder treatment, when patients are at higher risk of relapse and while they are gaining skills through psychotherapy and making other life changes.” But there can be pitfalls. Because semaglutide works by changing the way the brain experiences reward, there is concern that it may also affect people’s mood and cause depression in those who are 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-harming behaviour” through its yellow card scheme to monitor the safety of medicines and 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.

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“It would not be ideal for patients to have to choose between reducing the harms associated with heavy drinking and losing some of their ability to enjoy life’s pleasures more generally, such as social interaction or sex, for example.”

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

“We want to make sure that alcohol use disorder treatment doesn’t cause anhedonia that makes it more likely to relapse into depression.”

Matt Field, professor of psychology at the University of Sheffield, adds: “Semaglutide can make you less likely to binge drink after one or two drinks.

“But there are many examples of drugs for addiction 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 (brand name Campral); disulfiram (Antabuse); and nalmefene.

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

The NHS says it is used to 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 where there are concerns about them relapsing; it acts 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 the amount a person drinks.

Another, more controversial option is treating patients with ketamine “for fun.”

Last year, researchers at the University of Exeter published results from a study of 96 people that showed a combination of cognitive behavioral therapy, talk therapy and low-dose ketamine helped alcoholics stay sober 162 out of 180 days over a six-day follow-up period. months. representing an 87 percent abstinence rate, the American Journal of Psychiatry reported.

Research leader Celia Morgan, professor of psychopharmacology, told Good Health: “We think ketamine facilitates psychological therapy by also affecting neuroplasticity in the brain which means it is able to learn more easily and by giving people people a new perspective on their problems through 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 Addictions School at the Royal College of Psychiatrists, says new pharmacological treatments for alcohol dependence “will always be welcome” but need to undergo “extensive research and rigorous clinical trials”.