Incretin-based therapies after bariatric surgery were associated with a 55% lower risk of new-onset AUD and a 41% lower risk of initiating MAUDs compared to non-IBT AOMs.
Does incretin-based therapy reduce new-onset alcohol use disorder and initiation of medications for AUD in adults who underwent bariatric surgery?
Incretin-based therapies are associated with a significantly lower risk of new-onset alcohol use disorder and initiation of medications for AUD compared with non-incretin antiobesity medications in patients with prior bariatric surgery.
Absolute Event Rate: 0% vs 0%
Importance Patients who have undergone bariatric surgery have an elevated risk for alcohol use disorder (AUD). Incretin-based therapies (IBTs) may be associated with reward pathways in addition to weight loss. Objective To evaluate whether IBT after bariatric surgery is associated with a lower risk of new-onset AUD and initiation of medications for AUD (MAUDs) compared with non-IBT antiobesity medications (AOMs). Design, Setting, and Participants This retrospective cohort study included 15 382 adults who underwent bariatric surgery and subsequently received an AOM between January 1, 2020, and January 1, 2024, with outcomes assessed up to 2 years after AOM initiation. Data were derived from a multi-institutional US electronic health record network. Propensity score matching (1:1) balanced baseline covariates. Data were analyzed September 14, 2025. Exposures Post–bariatric surgery treatment with an IBT (semaglutide, liraglutide, or tirzepatide) vs non-IBT AOMs (orlistat, phentermine, low-dose naltrexone, benzphetamine, phendimetrazine, or diethylpropion). Main Outcomes and Measures Outcomes of interest were incidence rates (per 1000 person-years) and hazard ratios (HRs) of new-onset AUD and initiation of MAUDs, estimated using Kaplan-Meier and Cox proportional hazards regression models. Results The study included 15 382 patients who underwent bariatric surgery and subsequently received AOMs (11 194 IBT mean (SD) age, 51.4 (11.6) years; 8855 women (79.1%); and 4188 non-IBT mean (SD) age, 45.1 (11.0) years; 3587 women (86.6%)). After propensity score matching, 3990 patients were included in each group. Use of IBT was associated with a lower incidence of AUD (2.4 vs 5.2 per 1000 person-years) and a lower hazard of developing AUD (HR, 0.45; 95% CI, 0.25-0.81; P = .006) vs non-IBT use. Use of IBT was also associated with a lower incidence of initiating MAUDs (15.2 vs 25.6 per 1000 person-years) and a lower hazard of MAUD initiation (HR, 0.59; 95% CI, 0.46-0.75; P lt; .001). Results were consistent across sensitivity analyses, including restriction to AOM initiation within 5 years of bariatric surgery and requiring 3 or more AOM prescriptions. Conclusions and Relevance In this cohort study of patients who underwent bariatric surgery, IBT was associated with a 55% lower risk of new-onset AUD and a 41% lower risk of initiation of MAUDs compared with non-IBT AOMs. These findings suggest potential neurobehavioral benefits associated with IBTs that may inform AOM selection in this high-risk population. Prospective studies are warranted to confirm these associations and examine long-term liver-related outcomes.
Fakhoury et al. (Mon,) reported a other. Incretin-based therapies after bariatric surgery were associated with a 55% lower risk of new-onset AUD and a 41% lower risk of initiating MAUDs compared to non-IBT AOMs.
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