Incretin-Based Therapies Reduce Risk of Alcohol Use Disorder After Bariatric Surgery: JAMA
A new study published in the Journal of American Medical Association showed that a considerably reduced risk of acquiring new-onset alcohol use disorder (AUD) was linked to the use of incretin-based therapies (IBT) after bariatric surgery.
Alcohol use disorder is more common in patients who have had bariatric surgery. In addition to weight reduction, IBTs may be linked to reward circuits. Thus, this study determined if, in comparison to non-IBT anti-obesity drugs (AOMs), IBT following bariatric surgery is linked to a decreased incidence of new-onset AUD and introduction of medications for AUD (MAUDs).
Patients who underwent bariatric surgery and then got an AOM from January 1, 2020, to January 1, 2024 were included in this retrospective cohort research. The results were evaluated up to two years after the AOM was started. A network of electronic health records from several US institutions provided the data. Baseline factors were balanced by propensity score matching (1:1).
Treatment with an IBT (semaglutide, liraglutide, or tirzepatide) against non-IBT AOMs (orlistat, phentermine, benzphetamine, low-dose naltrexone, phendimetrazine, or diethylpropion) following bariatric surgery was studied. The Kaplan-Meier and Cox proportional hazards regression models were used to assess the incidence rates (per 1000 person-years) and hazard ratios (HRs) of new-onset AUD and beginning of MAUDs.
15,382 individuals who had bariatric surgery and then received AOMs were included in the research. Each group had 3990 patients after propensity score matching. When compared to non-IBT usage, IBT use was linked to a reduced incidence of AUD (2.4 vs. 5.2 per 1000 person-years) and a decreased risk of acquiring AUD (HR, 0.45; 95% CI, 0.25-0.81; P =.006).
A reduced incidence of MAUD initiation (15.2 vs. 25.6 per 1000 person-years) and a decreased risk of MAUD initiation (HR, 0.59; 95% CI, 0.46-0.75; P <.001) were also linked to the use of IBT. Sensitivity studies yielded consistent results, including the need for three or more AOM prescriptions and the restriction to starting AOM within five years following bariatric surgery.
Overall, sensitivity studies consistently showed that IBT was linked to a much decreased probability of developing AUD and starting MAUDs when compared to non-IBT AOMs. These findings imply that IBTs may have neurobehavioral advantages that lessen alcohol-related damage in addition to their effectiveness in promoting weight reduction.
Source:
Fakhoury, B., Sierra, L., Rama, K., Jahagirdar, V., Díaz, L. A., & Arab, J. P. (2025). Incretin-based therapies and post-bariatric surgery alcohol use disorder. JAMA Network Open, 8(12), e2549086. https://doi.org/10.1001/jamanetworkopen.2025.49086
