Exenatide once weekly for alcohol use disorder investigated in a randomized, placebo-controlled clinical trial
Mette Kruse Klausen, Mathias Ebbesen Jensen, Marco Møller, Nina Le Dous, Anne-Marie Østergaard Jensen, Victoria Alberte Zeeman, Claas-Frederik Johannsen, Alycia Lee, Gerda Krog Thomsen, Julian Macoveanu, Patrick MacDonald Fisher, Matthew Paul Gillum, Niklas Rye Jørgensen, Marianne Lerbæk Bergmann, Henrik Enghusen Poulsen, Ulrik Becker, Jens Juul Holst, Helene Benveniste, Nora D Volkow, Sabine Vollstädt-Klein, Kamilla Woznica Miskowiak, Claus Thorn Ekstrøm, Gitte Moos Knudsen, Tina Vilsbøll, Anders Fink-Jensen, Mette Kruse Klausen, Mathias Ebbesen Jensen, Marco Møller, Nina Le Dous, Anne-Marie Østergaard Jensen, Victoria Alberte Zeeman, Claas-Frederik Johannsen, Alycia Lee, Gerda Krog Thomsen, Julian Macoveanu, Patrick MacDonald Fisher, Matthew Paul Gillum, Niklas Rye Jørgensen, Marianne Lerbæk Bergmann, Henrik Enghusen Poulsen, Ulrik Becker, Jens Juul Holst, Helene Benveniste, Nora D Volkow, Sabine Vollstädt-Klein, Kamilla Woznica Miskowiak, Claus Thorn Ekstrøm, Gitte Moos Knudsen, Tina Vilsbøll, Anders Fink-Jensen
Abstract
BackgroundAlcohol use disorder (AUD) is a chronic, relapsing brain disorder that accounts for 5% of deaths annually, and there is an urgent need to develop new targets for therapeutic intervention. The glucagon-like peptide-1 (GLP-1) receptor agonist exenatide reduces alcohol consumption in rodents and nonhuman primates, but its efficacy in patients with AUD is unknown.MethodsIn a randomized, double-blinded, placebo-controlled clinical trial, treatment-seeking AUD patients were assigned to receive exenatide (2 mg subcutaneously) or placebo once weekly for 26 weeks, in addition to standard cognitive-behavioral therapy. The primary outcome was reduction in number of heavy drinking days. A subgroup also completed functional MRI (fMRI) and single-photon emission CT (SPECT) brain scans.ResultsA total of 127 patients were enrolled. Our data revealed that although exenatide did not significantly reduce the number of heavy drinking days compared with placebo, it significantly attenuated fMRI alcohol cue reactivity in the ventral striatum and septal area, which are crucial brain areas for drug reward and addiction. In addition, dopamine transporter availability was lower in the exenatide group compared with the placebo group. Exploratory analyses revealed that exenatide significantly reduced heavy drinking days and total alcohol intake in a subgroup of obese patients (BMI > 30 kg/m2). Adverse events were mainly gastrointestinal.ConclusionThis randomized controlled trial on the effects of a GLP-1 receptor agonist in AUD patients provides new important knowledge on the effects of GLP-1 receptor agonists as a novel treatment target in addiction.Trial registrationEudraCT: 2016-003343-11. ClinicalTrials.gov (NCT03232112).FundingNovavi Foundation; Research Foundation, Mental Health Services, Capital Region of Denmark; Research Foundation, Capital Region of Denmark; Ivan Nielsen Foundation; A.P. Moeller Foundation; Augustinus Foundation; Woerzner Foundation; Grosserer L.F. Foghts Foundation; Hartmann Foundation; Aase and Ejnar Danielsen Foundation; P.A. Messerschmidt and Wife Foundation; and Lundbeck Foundation.
Keywords: Addiction; Clinical Trials; Neuroimaging; Neuroscience; Pharmacology.
Conflict of interest statement
Conflict of interest: AFJ has received an unrestricted research grant from Novo Nordisk A/S to investigate the effects of GLP-1 receptor stimulation on weight gain and metabolic disturbances in patients with schizophrenia treated with an antipsychotic. TV has served on scientific advisory panels for, been part of speaker’s bureaus for, served as a consultant to, and/or received research support from Amgen, AstraZeneca, Boehringer Ingelheim, Eli Lilly, Gilead, Mundipharma, MSD/Merck, Novo Nordisk, and Sun Pharmaceutical Industries. HB has received honoraria from Washington University Seminar. JJH has received consulting fees from Novo Nordisk A/S and grants from the Novo Nordisk Foundation. GMK has received personal honoraria from Sage Biogen, H. Lundbeck A/S, and Sanos and serves as president of the European College of Neuropsychopharmacology (unpaid) and chair of the Science and Infrastructure Advisory Board for the Human Brain Project (personal honorarium). SVK has received grants from the German Research Foundation. JM has received honoraria from H. Lundbeck A/S. KWM has received honoraria from H. Lundbeck A/S and Janssen. The funding sources and the manufacturer of exenatide once weekly (Bydureon, AstraZeneca) had no influence on the trial design or data analysis.
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