Patients undergoing bariatric surgery who subsequently receive incretin-based therapies (IBT) may face a significantly lower risk of developing alcohol utilize disorder (AUD) compared to those prescribed other anti-obesity medications, according to a retrospective study published this week.
The analysis, involving over 15,000 adults who underwent bariatric surgery, revealed a 55% reduction in the incidence of new-onset AUD among those treated with IBTs – including semaglutide, liraglutide, and tirzepatide – versus those receiving non-IBT alternatives like orlistat and phentermine. Researchers also observed a 41% decrease in the initiation of medications specifically for AUD within the IBT group.
“After bariatric surgery, many patients do incredibly well metabolically, but we also observe a real and clinically important rise in alcohol-related risk in a subset,” said Dr. Juan Pablo Arab, associate professor of medicine at Virginia Commonwealth University School of Medicine and director of alcohol sciences at the Stravitz-Sanyal Institute for Liver Disease and Metabolic Health. “At the same time, incretin-based therapies are being used more and more after surgery for inadequate weight loss or weight regain, and there is growing interest that these drugs may affect reward pathways, not just weight.”
The study, utilizing data from 15,382 adults, compared 11,194 patients receiving IBTs to 4,188 receiving non-IBT anti-obesity medications. Researchers employed propensity score matching to create comparable cohorts of 3,990 patients each, analyzing outcomes for up to two years following the start of anti-obesity treatment. AUD incidence rates were 2.4 per 1,000 person-years in the IBT group compared to 5.2 per 1,000 person-years in the non-IBT group (HR = 0.45; 95% CI, 0.25-0.81). Initiation of AUD medications occurred at a rate of 15.2 per 1,000 person-years with IBTs versus 25.6 per 1,000 person-years with non-IBTs (HR = 0.59; 95% CI, 0.46-0.75).
While the findings suggest a potential protective effect of IBTs, researchers cautioned that the study’s retrospective nature and the possibility of unmeasured confounders, such as detailed alcohol consumption patterns, limit definitive conclusions. The short follow-up duration also warrants further investigation.
“What I found reassuring is that the association held up across sensitivity analyses, including different analytic windows and comparisons,” Dr. Arab stated. He emphasized that the results do not constitute a recommendation to use IBTs as a treatment for AUD, but rather highlight the require for continued research and, crucially, routine screening, counseling, and early intervention for alcohol misuse following bariatric surgery.
The study builds on growing interest in the potential impact of incretin-based therapies on reward pathways, as noted by Dr. Arab. Recent research has indicated that IBTs, initially developed for diabetes and obesity management, may influence brain regions involved in addiction. Further studies are needed to elucidate the mechanisms underlying these effects and to determine the clinical implications for post-bariatric surgery patients.
