GLP-1 Drugs and Other Emerging Therapies May Help Prevent Alcohol Relapse in Liver Disease Patients | Research

The takeaway

GLP-1 receptor agonists and FGF21 analogs are among emerging peptide-based therapies showing early promise for preventing alcohol relapse in people with liver disease, but existing proven drugs remain dramatically underused.

Pharmacotherapy widely underutilized
Despite guideline support, anti-relapse drugs are rarely prescribed for alcohol-associated liver disease patients due to stigma, provider inexperience, and fragmented care

What the researchers found

This review examines drugs that can prevent alcohol relapse in patients with alcohol-associated liver disease (ALD). Established medications like naltrexone and acamprosate reduce relapse in general alcohol use disorder but have limited data specifically in liver disease patients. Baclofen is the only drug tested in randomized trials in patients with cirrhosis, showing early benefit but mixed results in later studies.

Notably, emerging peptide-based therapies show early promise: GLP-1 receptor agonists, FGF21 (fibroblast growth factor-21) analogs, and psilocybin are all showing early signals for reducing alcohol use. Despite guideline support, these medications remain dramatically underused due to stigma, lack of provider training, and fragmented care.

Why it matters

Alcohol-associated liver disease is a leading cause of liver transplantation, and relapse after abstinence is the primary driver of disease progression and post-transplant failure. The emergence of GLP-1 receptor agonists and FGF21 analogs as potential anti-relapse therapies is particularly significant because these peptide drugs could simultaneously treat metabolic liver disease and reduce alcohol cravings — addressing two problems with one medication class.

The numbers in context

Established drugs: naltrexone, acamprosate, baclofen · Emerging agents: GLP-1 RAs, FGF21 analogs, psilocybin · pharmacotherapy remains underutilized in ALD

How the study worked

This is a narrative review that summarizes the published evidence for pharmacotherapies used to prevent alcohol relapse, with a focus on their application in patients with alcohol-associated liver disease. The authors evaluate both established and emerging drug therapies and discuss barriers to their clinical adoption.

Who was studied

Review article covering patients with alcohol use disorder and alcohol-associated liver disease, including pre- and post-transplant populations

What this study cannot tell us

As a narrative review, this paper does not present new data or conduct systematic analysis. Most drug evidence comes from general alcohol use disorder populations rather than liver disease patients specifically. The emerging therapies (GLP-1 RAs, FGF21 analogs) are described as having 'early signals' only, meaning robust clinical trial data is still needed.

How to read the evidence

This is a narrative review published in a gastroenterology journal. It summarizes existing evidence rather than generating new data. The established drugs have moderate evidence from general AUD populations, while the emerging peptide therapies (GLP-1 RAs, FGF21 analogs) have only early-stage evidence, warranting a low overall evidence rating.

When this study was published

Published in 2025, this is a very current review that captures the latest thinking on pharmacotherapy for alcohol relapse in liver disease, including the emerging interest in GLP-1 drugs for addiction.

The bigger picture

The discovery that GLP-1 receptor agonists may reduce alcohol use has been one of the most unexpected and exciting developments in addiction medicine. Originally developed for diabetes and obesity, these peptide drugs appear to dampen reward-seeking behavior more broadly. Combined with FGF21 analogs — another peptide-based therapy with liver-protective and appetite-modulating properties — the field may be approaching a paradigm shift where metabolic peptide drugs become dual-purpose treatments for both liver disease and the addiction driving it.

Questions still open

Will GLP-1 receptor agonists prove effective for alcohol relapse prevention in dedicated randomized controlled trials in liver disease patients?
Could FGF21 analogs simultaneously treat liver fibrosis and reduce alcohol cravings, making them ideal dual-action drugs for ALD?
What combination of pharmacotherapy and behavioral intervention will prove most effective for preventing relapse in the transplant setting?

Common questions

Can GLP-1 drugs like semaglutide help people stop drinking?

Early evidence suggests GLP-1 receptor agonists may reduce alcohol use by dampening reward-seeking behavior in the brain. Several observational studies and early trials have shown promising signals, but dedicated randomized controlled trials are still needed to confirm this effect. The potential is exciting because these drugs could treat both metabolic disease and addiction simultaneously.

Why aren't doctors prescribing anti-relapse drugs for liver disease patients?

Despite guideline recommendations, several barriers prevent widespread use: stigma around addiction, lack of training among hepatologists in addiction medicine, concerns about drug safety in patients with liver damage, and fragmented care systems where liver specialists and addiction specialists rarely coordinate. Integrated care programs are beginning to address these gaps.

Read the original research

Pharmacotherapy to Prevent Alcohol Relapse in Alcohol-Associated Liver Disease.

Current gastroenterology reports, 27(1), 74

View on PubMed ↗Publisher’s paper ↗

Citation

Zhang, Wei; Hwang, Soo Young; Luther, Jay. (2025). Pharmacotherapy to Prevent Alcohol Relapse in Alcohol-Associated Liver Disease.. Current gastroenterology reports, 27(1), 74. https://doi.org/10.1007/s11894-025-01026-x