Repurposing incretin-based therapies for alcohol use disorder: a systematic review of efficacy and safety relative to standard pharmacotherapies in a recent comparative context
Abstract
Background:: Alcohol use disorder (AUD) affects millions worldwide, but current treatments, such as disulfiram, naltrexone, acamprosate, and topiramate, have limitations in efficacy and tolerability. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), commonly used for diabetes and obesity, may offer a new approach by targeting brain pathways involved in alcohol cravings.
Objectives:: This review aims to systematically evaluate the preliminary efficacy and safety of GLP-1 RAs and other incretin-based therapies in treating AUD within a recent comparative context, alongside standard pharmacotherapies.
Design:: Systematic review.
Data sources and methods:: A comprehensive literature review was conducted by searching the PubMed/Medline, Web of Science, and Scopus databases from February through June 2025. The studies included were either randomized controlled trials (RCTs) or observational studies, written in English. Studies were selected based on their evaluation of GLP-1 RAs or comparator drugs in reducing alcohol consumption or related outcomes in patients with AUD.
Results:: The selected 12 studies correspond to a population of 95,004 participants, but only 663 were from RCTs, while the majority were from a single registry cohort. Emerging data suggest GLP-1 RAs may reduce heavy drinking days, particularly in individuals with a higher BMI. Furthermore, observational analyses indicate a potential association between GLP-1 RA use and reduced alcohol-related hospitalizations, while metabolic data suggest biologically plausible, albeit unconfirmed, hepatoprotective effects.
Conclusion:: While the large, aggregated sample size highlights the therapeutic promise of GLP-1 RAs for AUD, particularly for patients with metabolic comorbidities, the heavy reliance on observational data precludes claims of clinical equivalence with established pharmacotherapies. Appropriately powered, dedicated RCTs are required to confirm direct efficacy and long-term safety.
Trial registration:: Not registered.
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BibTeX
@article{alevizopoulos2026repurposing,
title = {{Repurposing incretin-based therapies for alcohol use disorder: a systematic review of efficacy and safety relative to standard pharmacotherapies in a recent comparative context}},
author = {Aristomenis G. Alevizopoulos and Vasileios Vasilakos and Iakovos Kritikos and Maria Alevizopoulou and Eleni Korompoki and Theodora Psaltopoulou and Stavroula A. Paschou},
journal = {Therapeutic Advances in Psychopharmacology},
year = {2026},
month = sep,
doi = {10.1177/20451253261457548},
url = {https://doi.org/10.1177/20451253261457548},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Repurposing incretin-based therapies for alcohol use disorder: a systematic review of efficacy and safety relative to standard pharmacotherapies in a recent comparative context
AU - Aristomenis G. Alevizopoulos
AU - Vasileios Vasilakos
AU - Iakovos Kritikos
AU - Maria Alevizopoulou
AU - Eleni Korompoki
AU - Theodora Psaltopoulou
AU - Stavroula A. Paschou
PY - 2026
DA - 2026/09/22
JO - Therapeutic Advances in Psychopharmacology
DO - 10.1177/20451253261457548
UR - https://doi.org/10.1177/20451253261457548
AB - Background:: Alcohol use disorder (AUD) affects millions worldwide, but current treatments, such as disulfiram, naltrexone, acamprosate, and topiramate, have limitations in efficacy and tolerability. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), commonly used for diabetes and obesity, may offer a new approach by targeting brain pathways involved in alcohol cravings. Objectives:: This review aims to systematically evaluate the preliminary efficacy and safety of GLP-1 RAs and other incretin-based therapies in treating AUD within a recent comparative context, alongside standard pharmacotherapies. Design:: Systematic review. Data sources and methods:: A comprehensive literature review was conducted by searching the PubMed/Medline, Web of Science, and Scopus databases from February through June 2025. The studies included were either randomized controlled trials (RCTs) or observational studies, written in English. Studies were selected based on their evaluation of GLP-1 RAs or comparator drugs in reducing alcohol consumption or related outcomes in patients with AUD. Results:: The selected 12 studies correspond to a population of 95,004 participants, but only 663 were from RCTs, while the majority were from a single registry cohort. Emerging data suggest GLP-1 RAs may reduce heavy drinking days, particularly in individuals with a higher BMI. Furthermore, observational analyses indicate a potential association between GLP-1 RA use and reduced alcohol-related hospitalizations, while metabolic data suggest biologically plausible, albeit unconfirmed, hepatoprotective effects. Conclusion:: While the large, aggregated sample size highlights the therapeutic promise of GLP-1 RAs for AUD, particularly for patients with metabolic comorbidities, the heavy reliance on observational data precludes claims of clinical equivalence with established pharmacotherapies. Appropriately powered, dedicated RCTs are required to confirm direct efficacy and long-term safety. Trial registration:: Not registered.
SN - 2045-1253
SN - 2045-1261
ER -