GLP-1 RA on Alcohol Consumption, Metabolism and Liver Parameters in Patients With Obesity and Fatty Liver Disease (GLP-1 RA)

February 23, 2026 updated by: Insel Gruppe AG, University Hospital Bern

Effect of Glucagon-like Peptide-1 Receptor Agonists (GLP-1 RA) on Alcohol Consumption, Metabolism and Liver Parameters in Patients With Obesity and Fatty Liver Disease

There is evidence that alcoholic beverage consumption significantly interacts with food energy intake. Furthermore, there is accumulating evidence showing independent, combined, and modifying effects of alcohol and metabolic factors on the onset and progression of chronic liver disease. Preclinical and clinical data have showed that GLP-1 RA can decrease alcohol consumption, particularly in obese patients. Moreover there is evidence that semaglutide can improve the liver sinusoidal milieu in pre-clinical models of cirrhosis.

In this study, the investigators aim to assess if patients treated with semaglutide and receiving counselling will achieve a significantly higher alcohol abstinence compared to patients only receiving counselling.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

In Switzerland, approximately 20% of the population is consuming more alcohol than recommended by the WHO. There is evidence that alcoholic beverage consumption significantly interacts with food energy intake. Although several studies have investigated the role of alcohol in obesity, there is still a lack of knowledge about specific roles of different types of alcoholic beverages and on the effect of consumption patterns in patients with metabolic syndrome and obesity. Nevertheless, there is accumulating evidence showing independent, combined, and modifying effects of alcohol and metabolic factors on the onset and progression of chronic liver disease.

Glucagon-like peptide-1 (GLP-1)-based therapy for type 2 diabetes was introduced in 2006. GLP-1 is an incretin hormone, which is secreted from endocrine L cells of the small intestine in response to nutrients in the gut lumen. Exendin-4 binds to the GLP-1R with high affinity and acts as a receptor agonist, thus referred to as GLP-1 receptor agonists (GLP-1 RA). To date the GLP-1 RA: dulaglutide, semaglutide, liraglutide, lixisenatide and exenatide are approved for the treatment of diabetes mellitus type II in Switzerland. Since 2020, the GLP-1 RA semaglutide is also approved for the treatment of obesity in Switzerland. GLP-1 RA have a well-established effect on the food reward system which is regulated by key mesolimbic brain regions, the ventral tegmental area (VTA) and nucleus accumbens (NAc)11. Interestingly, these regions are also involved in the rewarding effects of drugs of abuse and alcohol. A link between alcohol intake and GLP-1 has been demonstrated in several preclinical studies and may play an important role in the development of addiction. The findings are consistent with the hypothesis that systemic administration of GLP-1 RA can influence the mesolimbic dopamine system and reward-seeking behaviours associated with alcohol use disorder (AUD). Furthermore, preclinical data has shown that GLP-1 RA, namely, liraglutide significantly improved liver microvascular function and exhibited anti-fibrotic effects of confirmed in human liver tissue.

In metabolic fatty liver disease, GLP-1 RA have a significant effect on reducing steatosis and inflammation. Obesity is one of the main risk factors for fatty liver disease, particularly central adiposity, and one of the leading drivers for liver disease progression, independent of the cause of liver disease. In a Swiss referral liver centre, 75% of patients with advanced cirrhosis have either alcohol, metabolic or combined factors (25%) as the cause for liver disease. Therapeutic strategies approaching both aetiologies are thus urgently needed.

The investigators aim to investigate in this study, whether there is a significant beneficial effect of GLP-1 RA, specifically semaglutide, on alcohol consumption, specifically in obese patients. Furthermore, the investigators aim to systematically assess drinking patterns and alcohol beverage consumption in patients with obesity assessed with the innovative direct alcohol biomarker phosphatidylethanol (PEth)24 that overcomes the problems of low reliability of medical history, standard questionnaires and previous tests in assessing recent alcohol consumption.

Study Type

Interventional

Enrollment (Estimated)

64

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • BMI ≥ 35 kg/m² OR BMI ≥ 28 kg/m² in the case of weight-related co-morbidities (pre-diabetes or type 2 diabetes mellitus, hypertension, dyslipidemia).
  • Fatty liver disease (steatosis on ultrasound and/or CAP value on FS > 238 dB/m)
  • Age 18 - 80 years
  • Alcohol Use Disorder Identification Test-C Score >4 (AUDIT-C) Score ≥4 for women and ≥5 for men (as measured from AUDIT-questionnaire distributed in visit 1)
  • Sufficient skills for German or French language (written and spoken)
  • Signed informed consent

Exclusion Criteria:

  • Active illicit substance use
  • AUDIT-score < 5 (males)/ 4 (females) (as measured from AUDIT-questionnaire distributed in visit 1)
  • Current treatment with drugs against alcohol dependence (disulfiram, acamprosate, naltrexone, baclofen and nalmefene)
  • Any known contraindication to semaglutide
  • Presence or history of a hepatic or extrahepatic malignancy from the previous 6 months

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Control Arm
Patients assigned to this arm will be treated with standard of care for weight reduction (nutritional and exercise recommendations) for 16 weeks.
Behavioral: Weight reduction recommendations (nutritional and exercise)
Participants will receive nutritional and exercise recommendations and 2 telephone consultations
Experimental: Semaglutide Arm
Patients assigned to this arm will be treated with semaglutide and standard of care for weight reduction (nutritional and exercise recommendations) for 16 weeks.
Behavioral: Weight reduction recommendations (nutritional and exercise)
Participants will receive nutritional and exercise recommendations and 2 telephone consultations
Drug: Semaglutide

Treatment with semaglutide, following standard clinical practice as per below schedule:

Week 1-4: Injected dose of 0,25 mg i.d. Week 5-8: Injected dose of 0,5 mg i.d. Week 9-12: Injected dose of 1,0 mg i.d. Week 13-16: Injected dose of 1,7 mg i.d. After week 16: Injected dose of 2,4 mg i.d.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Proportion of patients achieving total alcohol abstinence (measured by negative PEth test)
Time Frame: From inclusion date (baseline) until end of the study, total duration 16 weeks per patient
Percentage of patients achieving total alcohol abstinence from baseline to follow-up after 16 weeks of treatment, measured by negative PEth test, in patients treated with semaglutide vs control.
From inclusion date (baseline) until end of the study, total duration 16 weeks per patient

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Pre and post treatment comparison of total abstinence (PEth test)
Time Frame: From inclusion date (baseline) until end of the study, total duration 16 weeks per patient
Change from baseline in number of patients with total alcohol abstinence as assessed by PEth test.
From inclusion date (baseline) until end of the study, total duration 16 weeks per patient
Pre and post treatment comparison of total abstinence (assessed by TFLB method)
Time Frame: From inclusion date (baseline) until end of the study, total duration 16 weeks per patient
Change from baseline in number of patients with total alcohol abstinence as assessed by TFLB method.
From inclusion date (baseline) until end of the study, total duration 16 weeks per patient
Pre and post treatment comparison of total abstinence (measured by negative EtG)
Time Frame: From inclusion date (baseline) until end of the study, total duration 16 weeks per patient
Change from baseline in number of patients with total alcohol abstinence measured by negative EtG.
From inclusion date (baseline) until end of the study, total duration 16 weeks per patient
Pre and post treatment comparison of cumulative abstinent days (by TFLB method)
Time Frame: From inclusion date (baseline) until end of the study, total duration 16 weeks per patient
Change from baseline in number of cumulative abstinent days per patient (measured by TFLB method).
From inclusion date (baseline) until end of the study, total duration 16 weeks per patient
Pre and post treatment comparison of drinking days (by TFLB method)
Time Frame: From inclusion date (baseline) until end of the study, total duration 16 weeks per patient
Change from baseline in number of drinking days per patient (measured by TFLB method).
From inclusion date (baseline) until end of the study, total duration 16 weeks per patient
Pre and post treatment comparison of number of drinks per week (by TFLB method)
Time Frame: From inclusion date (baseline) until end of the study, total duration 16 weeks per patient
Change from baseline in number of drinks per week per patient (measured by TFLB method).
From inclusion date (baseline) until end of the study, total duration 16 weeks per patient
Percentage reduction in transient liver elastography levels assessed by Fibroscan
Time Frame: From inclusion date (baseline) until end of the study, total duration 16 weeks per patient
Percentage reduction in transient liver elastography levels by vibration controlled transient elastography (Fibroscan) from baseline until after 16 weeks of therapy (both study arms).
From inclusion date (baseline) until end of the study, total duration 16 weeks per patient
Percentage reduction in transient liver elastography levels assessed by FIB-4 score
Time Frame: From inclusion date (baseline) until end of the study, total duration 16 weeks per patient
Percentage reduction in transient liver elastography levels by FIB-4 score (fibrosis assessment including age, AST, ALT and platelet count) from baseline until after 16 weeks of therapy (both study arms).
From inclusion date (baseline) until end of the study, total duration 16 weeks per patient
Percentage reduction in metabolic markers
Time Frame: From inclusion date (baseline) until end of the study, total duration 16 weeks per patient
Percentage reduction in metabolic markers (both study arms): body weight, BMI, fasting glucose, homeostatic model assessment of insulin resistance (HOMA-IR), HbA1c levels from baseline until 16 weeks after therapy
From inclusion date (baseline) until end of the study, total duration 16 weeks per patient
Proportion of patients achieving total alcohol abstinence (measured by TFLB method)
Time Frame: From inclusion date (baseline) until end of the study, total duration 16 weeks per patient
Percentage of patients achieving total alcohol abstinence from baseline to follow-up after 16 weeks of treatment, measured by TFLB method, in patients treated with semaglutide vs control.
From inclusion date (baseline) until end of the study, total duration 16 weeks per patient
Proportion of patients maintaining total alcohol abstinence (measured by negative EtG)
Time Frame: From inclusion date (baseline) until end of the study, total duration 16 weeks per patient
Percentage of patients maintaining total alcohol abstinence from baseline to follow-up after 16 weeks of treatment, measured by negative EtG in patients treated semaglutide vs. control
From inclusion date (baseline) until end of the study, total duration 16 weeks per patient
Change of alcohol abstinent days (cumulative abstinent days, by TFLB method)
Time Frame: From inclusion date (baseline) until end of the study, total duration 16 weeks per patient
Assessment of change in percentage of alcohol abstinent days after treatment compared to before treatment with semaglutide vs. control (measured by TFLB method)
From inclusion date (baseline) until end of the study, total duration 16 weeks per patient
Change of heavy drinking days (by TFLB method)
Time Frame: From inclusion date (baseline) until end of the study, total duration 16 weeks per patient
Assessment of change in percentage of heavy drinking days after treatment compared to before treatment with semaglutide vs. control (measured by TFLB method)
From inclusion date (baseline) until end of the study, total duration 16 weeks per patient
Change of total number of drinks per week (by TFLB method)
Time Frame: From inclusion date (baseline) until end of the study, total duration 16 weeks per patient
Assessment of change in percentage of total number of drinks per week after treatment compared to weeks before treatment with semaglutide vs. control (measured by TFLB method)
From inclusion date (baseline) until end of the study, total duration 16 weeks per patient
Effects of semaglutide on reward and relief drinking behavior
Time Frame: From inclusion date (baseline) until end of the study, total duration 16 weeks per patient
Assessments of effects of semaglutide on reward and relief drinking behavior (assessed with the Alcohol Expectancy Questionnaire, both study arms).
From inclusion date (baseline) until end of the study, total duration 16 weeks per patient
Safety profile of semaglutide in described population
Time Frame: From inclusion date (baseline) until end of the study, total duration 16 weeks per patient
Number and description of SAE's concerning semaglutide in described population (semaglutide arm only).
From inclusion date (baseline) until end of the study, total duration 16 weeks per patient
Effect of GLP-1 RA therapy on TMA/TMAO pathway
Time Frame: From inclusion date (baseline) until end of the study, total duration 16 weeks per patient
Statistically significant % reduction of TMAO levels (measured by blood test at baseline and after 16 weeks of therapy, semaglutide arm only).
From inclusion date (baseline) until end of the study, total duration 16 weeks per patient

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Insel Gruppe AG, University Hospital Bern

Investigators

  • Principal Investigator: Susana Gomes Rodrigues, MD, University Hospital Bern (Inselspital), Hepatology

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

May 1, 2026

Primary Completion (Estimated)

December 31, 2026

Study Completion (Estimated)

April 30, 2027

Study Registration Dates

First Submitted

August 6, 2024

First Submitted That Met QC Criteria

August 6, 2024

First Posted (Actual)

August 9, 2024

Study Record Updates

Last Update Posted (Actual)

February 25, 2026

Last Update Submitted That Met QC Criteria

February 23, 2026

Last Verified

February 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 2023-01715

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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