July 21, 2026

expert reaction to a multi-target trial emulation study looking at GLP- 1 receptor agonists and alcohol-related hospitalisations among adults with alcohol use disorder

A study published in BMJ Open looks at GLP-1 use and alcohol-related hospitalisations among adults with alcohol use disorder.

Prof Ashwin Dhanda, Professor of Liver Medicine, University of Plymouth, said:

“This study adds to the growing evidence that GLP-1 receptor agonists reduce alcohol use and alcohol-related health harms. It uses routinely collected healthcare data to simulate a clinical trial of GLP-1 RAs versus other diabetes, obesity or alcohol use disorder medications in people with alcohol disorder and diabetes or obesity.  It shows significant reductions in risk of alcohol-related hospitalisation within the first year of starting GLP-1 RA treatment.

“Its strengths include a large study population, groups that are well matched in terms of their characteristics and comparison of new versus older types of GLP-1 RAs. However, it still suffers from the bias of using previously collected data in people that were accessing healthcare for other reasons. It may not be representative of a broader population of people with alcohol use disorder (some of whom may not access standard healthcare settings). Its design cannot tell us for certain whether GLP-1 RAs are effective for the treatment of alcohol use disorder, only that there is an association between newer GLP-1 RAs and reduction in alcohol-related hospital attendance. It does not tell us about the safety and side effects of GLP-1 RAs in this population. The study cannot be used by the FDA to approve GLP-1 RAs for alcohol use disorder treatment.

“To definitively answer the question of whether GLP-1 RAs are safe and effective for the treatment of alcohol use disorder, a well-designed placebo controlled randomised clinical trial is needed. This should include a diverse population of people from different backgrounds who suffer with alcohol use disorder, not just those who have health insurance or who access to specialist healthcare. It needs to test GLP-1 RAs in real patients, with other real health and social problems.”

Dr Marie Spreckley, Weight Management Researcher, University of Cambridge, said:

“This observational study found that adults with alcohol use disorder and type 2 diabetes or obesity who initiated semaglutide or tirzepatide had a lower observed risk of alcohol-related hospitalisation than those receiving comparator treatments. The study uses several robust epidemiological methods, including target trial emulation, active comparator groups, propensity score adjustment and negative control analyses, which strengthen confidence in the observed associations. However, as with all observational studies, these methods cannot establish that GLP-1 receptor agonists directly caused the observed reduction in risk.

“The authors appropriately acknowledge the study’s limitations. Although extensive statistical adjustment was undertaken, electronic health records cannot fully account for factors such as alcohol use disorder severity, healthcare engagement and socioeconomic circumstances, meaning residual confounding remains possible.

“Overall, these findings add to growing observational evidence suggesting that GLP-1 receptor agonists may influence alcohol-related outcomes. However, dedicated randomised controlled trials are needed to determine whether these medicines reduce alcohol consumption and alcohol-related harm before they can be considered an evidence-based treatment for alcohol use disorder.”

Prof Colin Angus, Professor of Alcohol Policy, Sheffield University Addictions Research Group, said:

“This looks like a reasonable study that adds to a growing body of evidence that GLP-1s may reduce alcohol-related harm.

“However, this is a US-based observational study, and newer GLP-1s are expensive treatments, meaning there may well be some important differences between the people taking GLP-1s and those not taking them that may not be fully controlled for. For example, it is more likely that people from more affluent groups, with better health insurance, can afford them. The authors of the study acknowledge this.

“I’d view this as adding a little more weight to the emerging evidence, rather than the definitive word on the matter.”

‘Association between GLP- 1 receptor agonists and alcohol- related hospitalisations among adults with alcohol use disorder: multi- target trial emulation study’ by Patricia J Rodriguez et al. was published in BMJ OPEN at 23:30 UK time Tuesday 21 July 2026. 

DOI: 10.1136/ bmjopen-2025-109259

Declared interests

Prof Ashwin Dhanda: “I am leading a clinical trial testing the efficacy of semaglutide to reduce alcohol use in people with alcohol use disorder and liver disease. Study drug and placebo is provided free of charge by the manufacturer (Novo Nordisk). The trial is funded by NIHR.”

Dr Marie Spreckley: “Dr Marie Spreckley is a Postdoctoral Researcher at IMS Epidemiology, University of Cambridge, where her research focuses on obesity, nutrition and incretin-based therapies. She has no personal financial interests, consultancy roles, advisory positions, speaker fees, stock ownership, or honoraria from manufacturers of GLP-1 or GIP/GLP-1 receptor agonists.”

Prof Colin Angus: “no interests to declare”