Semaglutide for alcohol use disorder missed its primary endpoint but cut heavy drinking days

The edition in brief

In a 50-person phase 2 trial in treatment-seeking adults with moderate to severe alcohol use disorder, eight weeks of oral semaglutide did not reduce laboratory cue-induced craving (the primary outcome) or drinks per day, but did reduce heavy drinking days, drinks per drinking day and alcohol-related consequences. That is encouraging but not enough to prescribe on; naltrexone and acamprosate remain the licensed, underused options. A Korean multicentre, double-blind trial randomised 93 adults with major depression or bipolar disorder to a smartphone app giving personalised circadian feedback or a sham app for a year; recurrence was lower with the active app (incidence rate ratio 3.39 in favour, 95% CI 1.86–6.17), though only 80 were analysed and the app is not available outside research. A Finnish register study of 604,819 adolescents found that peers' mental disorder diagnoses and family-based genetic risk were associated with the adolescent's own later diagnoses, most strongly in upper secondary school; this is association, and mechanisms are unknown. An updated meta-analysis of 24 studies found no baseline inflammatory marker, CRP included, that separated antidepressant responders from non-responders in the main analysis. The pearl is a reminder to offer licensed alcohol pharmacotherapy.