Abstract
IMPORTANCE: Alcohol use is a leading cause of morbidity and mortality worldwide. Growing evidence suggests that glucagon-like peptide-1 receptor agonists (GLP-1RAs) may represent a novel potential pharmacotherapeutic tool for alcohol use disorder (AUD). OBJECTIVE: To examine the association between GLP-1RA prescriptions and alcohol use. DESIGN: This cohort study used a cross-sectional measure of alcohol consumption and longitudinal electronic health record (EHR) data collected between 1981 and October 2023 from NIH's All of Us Research Program participants. SETTING: All of Us is a large program to recruit and collect surveys, EHR, genomic, and wearable data from a wide array of Americans. The data presented here are from the All of Us Curated Data Repository version 8. PARTICIPANTS: 393,596 All of Us participants with EHR data recruited across the United States. EXPOSURE: At least two GLP-1RA prescription records in the EHR. MAIN OUTCOMES AND MEASURES: Alcohol Use Disorders Identification Test (AUDIT-C) scores and responses to individual AUDIT-C questions. RESULTS: Among 15,447 participants with at least two recorded GLP-1RA prescriptions on separate days, 3650 had active GLP-1RA prescriptions, 5642 would have future GLP-1RA prescriptions (primary comparison group), and 544 had former GLP-1RA prescriptions. Those with active GLP-1RA prescriptions had statistically significant but modestly lower AUDIT-C scores on average compared with those with future prescriptions (incidence rate ratio [IRR] of 0.95; 95% CI, 0.91-0.99; P = 0.01). Participants with a former GLP-1RA prescription had lower AUDIT-C scores compared with those with future prescriptions, but this difference was not statistically significant. Results were similar using a propensity-score matched comparison group with a lower average AUDIT-C score for the current GLP-1RA group (IRR = 0.89; 95% CI, 0.85-0.93; P = <0.001) and no significant difference for the former prescription group. Analysis of individual AUDIT-C questions shows a significant association with GLP-1RA prescriptions and frequency of drinking but not drinks per occasion or binge drinking. CONCLUSIONS AND RELEVANCE: This study's findings indicate that GLP-1RAs may reduce alcohol consumption by decreasing use frequency. Experimental studies and randomized controlled trials are needed to test the mechanisms and potential efficacy of GLP-1RAs in people with AUD.