Association of GLP-1 Receptor Agonist Prescriptions and Alcohol Consumption in the National Institutes of Health's All of Us Cohort

ImportanceAlcohol 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). ObjectiveTo examine the association between GLP-1RA prescriptions and alcohol use. DesignThis cohort study used a cross-sectional measure of alcohol consumption and longitudinal electronic health record (EHR) data collected between 1981 and October 2023 from NIHs All of Us Research Program participants. SettingAll 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. Participants393,596 All of Us participants with EHR data recruited across the United States. ExposureAt least two GLP-1RA prescription records in the EHR. Main Outcomes and MeasuresAlcohol Use Disorders Identification Test (AUDIT-C) scores and responses to individual AUDIT-C questions. ResultsAmong 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 RelevanceThis studys 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. KEY POINTSO_ST_ABSQuestionC_ST_ABSIs there an association between glucagon-like peptide-1 receptor agonist (GLP-1RA) prescriptions and alcohol consumption? FindingsIn this observational cohort study of 15 447 people with GLP-1RA prescriptions in NIHs All of Us cohort, active GLP-1RA prescriptions were associated with significantly lower Alcohol Use Disorders Identification Test (AUDIT-C) scores compared with scores of those who would have GLP-1RAs in the future and of a matched comparison group with no GLP-1RAs. People with former GLP-1RAs did not have lower AUDIT-C scores than these comparison groups. MeaningActive GLP-1RA use may be effective in reducing alcohol consumption.