Abstract
OBJECTIVES: To evaluate trends in newly filled GLP-1 receptor agonist (GLP-1RA) prescriptions among U.S. adults with type 2 diabetes (T2DM) and/or obesity, comparing those with and without comorbid alcohol use disorder (AUD), and to assess differences in their demographic and clinical characteristics. METHODS: We used national claims data from Optum Labs Data Warehouse, which includes de-identified administrative and pharmacy claims from commercially insured and Medicare Advantage (MA) enrollees throughout the U.S., to identify adults who newly filled GLP-1RA-based prescriptions between April 1, 2016, and March 31, 2024. We calculated quarterly rates of new GLP-1RA fills per 100 person-years and compared the characteristics of individuals with T2DM and/or obesity with and without comorbid AUD. RESULTS: From 2016 to 2024, 555,224 individuals with T2DM and/or obesity newly filled prescriptions for GLP-1RAs, of whom 6606 had comorbid AUD. The rate of new GLP-1RA fills for individuals with comorbid AUD increased from 1.27 to 6.02 per 100 person-years between 2016-2024 [incident rate ratio (IRR): 4.73 (95% CI 3.38, 6.79)], compared with an increase of 2.21 to 6.55 per 100 person-years among individuals without comorbid AUD [IRR: 2.96 (95% CI 2.88, 3.05)]. Individuals with AUD were more likely to be MA enrollees under age 65, male, have had a recent emergency department visit, and have co-occurring psychiatric and medical conditions compared with those without comorbid AUD. CONCLUSIONS: From 2016 to 2024, the rate of newly filled GLP-1RA prescriptions increased among individuals with T2DM and/or obesity and comorbid AUD. Individuals with comorbid AUD were more likely to be male and to have clinical characteristics linked to greater AUD severity. Additional clinical studies on the efficacy and safety of GLP-1RAs for AUD are needed to guide their appropriate use.