Impact of glucagon-like peptide-1 receptor agonists on alcohol consumption and liver-related outcomes: A systematic review and meta-analysis.

BACKGROUND

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have demonstrated potential in reducing alcohol intake and impacting liver-related outcomes, mostly in patients with alcohol use disorder (AUD). This systematic review and meta-analysis aimed to further assess this association based on current evidence.

METHODS

A comprehensive search of PubMed, Embase, and CENTRAL was performed in May 2025. Random-effects meta-analyses or narrative synthesis were conducted depending on data availability. The pooled effect size was standardized mean difference (SMD), incidence rate ratio (IRR) or hazard ratio (HR) with 95 % confidence intervals (95 % CI).

FINDINGS: Eleven studies (3 RCTs, 8 observational) including 263,616 patients (124,884 on GLP-1RAs, 138,732 controls) were included; 8 provided sufficient data for meta-analysis. In narratively summarized results, GLP-1RAs use was associated with reduced alcohol intake, binge drinking, AUDIT scores, and all-cause mortality. Evidence on heavy drinking was mixed, progression to cirrhosis was not statistically different and adverse events were mostly mild. In the pooled analysis of alcohol intake, no significant difference was observed with GLP-1RAs use (SMD -0.17; 95 % CI: -0.39, 0.04; I² = 0.0 %). However, GLP-1RAs use was associated with reduced alcohol-related events (HR 0.56; 95 % CI: 0.48, 0.65; I² = 63.6 %) and reduced liver-related outcomes (IRR 0.65; 95 % CI: 0.50, 0.85; I² = 0.0 %).

CONCLUSIONS

This meta-analysis outlines that GLP-1RAs may reduce alcohol-related events and liver-related outcomes, despite no significant effect was observed on pooled alcohol intake. Further high-quality studies are warranted to establish the efficacy of GLP1-RAs in reducing alcohol use and mitigating liver injury.