GLP-1 receptor agonists in patients with alcohol use disorder and related liver disease: a systematic review and meta-analysis

Abstract Background Emerging evidence suggests that glucagon-like peptide 1 receptor agonists (GLP-1RAs) may help to reduce alcohol consumption in patients with alcohol use disorder (AUD). Given recent findings indicating their potential effectiveness in alcohol-related liver disease (ArLD), this study aims to systematically review the role of GLP-1RAs in patients with ArLD or AUD. Methods Based on the PRISMA guidelines, eligible studies included adults with AUD or ArLD treated with GLP-1RAs. The primary outcome was the development of hepatic decompensation. Results Six studies encompassing 1,332,698 participants were included in this study. In the three studies included in this meta-analysis, we demonstrated that GLP-1 RA therapy in patients with ArLD and T2D significantly reduced the risk of hepatic decompensation (hazard ratio (HR): 0.64; 95% CI 0.51–0.79; p < 0.0001; I 2 = 0%). While individual studies showed mixed results regarding other liver-related outcomes, consistent benefits were observed in reducing mortality and liver failure in selected cohorts. In patients with AUD, GLP-1 RAs were associated with a reduced risk of developing ArLD (HR, 0.62; 95% CI 0.44–0.87) and all-cause mortality (HR, 0.53; p < 0.001). Conclusions GLP-1RAs may offer favorable hepatic and survival outcomes in patients with AUD and/or ArLD, especially in those with type 2 diabetes. Despite promising observational findings, the lack of RCTs has impeded strong recommendations.