Presentation (CTI)

OBJECTIVES: To evaluate the association between GLP-1 receptor agonist (GLP-1RA) initiation and incident Alcohol Use Disorder (AUD) and alcohol-related medical conditions using a U.S. administrative claims database.
METHODS: We conducted a retrospective cohort study using U.S. administrative claims from 2019-2025. Adults with ≥6 months of continuous pre-index enrollment who initiated a GLP-1RA (semaglutide, tirzepatide, liraglutide, dulaglutide, or exenatide) were closely matched to non-GLP-1RA comparators on age, gender, insurance type, obesity and diabetes diagnoses, and baseline alcohol-related history. Outcomes included incident AUD (ICD-10: F10*) and alcohol-related medical conditions: alcoholic liver disease (K70*), alcohol-induced pancreatitis (K85.2*; K86.0), alcohol-related neurologic disorders (G31.2; G62.1), and alcoholic cardiomyopathy (I42.6). Incidence rates were calculated using person-time methods; incidence rate ratios (IRRs) with Poisson confidence intervals were estimated.
RESULTS: The study included approximately 2.9 million GLP-1RA initiators and 5.9 million matched controls, contributing over 600,000 person-years of follow-up. GLP-1RA initiation was associated with a lower incidence of newly diagnosed AUD (IRR 0.92; 95% CI 0.88-0.96). Larger relative reductions were observed for downstream alcohol-related medical conditions, including alcoholic liver disease (IRR 0.77; 95% CI 0.71-0.83), alcohol-induced pancreatitis (IRR 0.44; 95% CI 0.34-0.57), and alcoholic cardiomyopathy (IRR 0.16; 95% CI 0.09-0.29). Reductions were directionally consistent across all evaluated outcomes.
CONCLUSIONS: In this large real-world analysis, GLP-1RA initiation was associated with a lower incidence of AUD and multiple alcohol-related medical conditions. These findings extend emerging mechanistic and behavioral evidence by demonstrating potential downstream reductions in clinically meaningful alcohol-related disease, suggesting GLP-1RAs may influence downstream alcohol-related disease burden beyond their established metabolic indications and warrant further prospective evaluation.