Semaglutide for Alcohol Use Disorder

Study Overview
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Brief Summary
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This is an early-Phase II human laboratory trial using a randomized, placebo-controlled, dose-ranging design to investigate the effects of semaglutide, a GLP-1 receptor agonist, on alcohol-related outcomes in adults with alcohol use disorder (AUD).

Detailed Description
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This is an early-Phase II human laboratory trial using a randomized, placebo-controlled, dose-ranging design to investigate the effects of semaglutide, a GLP-1 receptor agonist, on laboratory alcohol responses and consumption, naturalistic alcohol consumption, and weight loss in participants with alcohol use disorder (AUD). Participants will attend weekly visits while semaglutide dosage is increased to 1.0mg over a period of approximately 9-10 weeks. Participants will attend weekly visits for medication or placebo administration. At scheduled intervals, participants will complete 4 laboratory sessions involving alcohol self-administration and alcohol challenge to characterize medication effects on alcohol-related outcomes.

Official Title
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Human Laboratory Screening of Semaglutide for Alcohol Use Disorder

Conditions
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Alcohol Use Disorder, Cigarette Smoking

Intervention / Treatment
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* Drug: Semaglutide
* Drug: Sham/placebo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 21-65 Meeting DSM-5 criteria for current (past year) alcohol use disorder (with 2-7 symptoms endorsed) and National Institute on Alcohol Abuse and Alcoholism (NIAAA) criteria for current at-risk drinking (i.e., >7/14 drinks in one week for women/men, with at least two episodes of 4+/5+ drinks in the past 30 days) Willingness/availability to take study medication and complete study procedures, including attending weekly visits for medication administration, side effect assessments, and glucose monitoring Willingness to complete laboratory sessions involving alcohol administration Ability to communicate and read in English Exclusion Criteria: Reporting past 30-day use of illicit drugs other than cannabis at baseline, or having a positive toxicology screen for illicit drugs other than cannabis at baseline Meeting past-year criteria for a substance use disorder (with the exception of alcohol, tobacco or mild cannabis use disorder) Current engagement in alcohol treatments, or currently engaged in intentional efforts to quit alcohol use Past 30-day use of: Sincalide, Sulfonylureas, insulin and insulin products or other medications that may interact with semaglutide;, or weight control medications Prior use of semaglutide or other GLP-1 agonists Known or suspected hypersensitivity to study medication or related products Lifetime diagnosis of severe mental illness (including schizophrenia and bipolar disorder) History of suicide attempt, or recent (past 30 day) suicidal ideation, or psychiatric hospitalization in the last 6 months Current significant medical or neurological illness (based on self-report or medical record) including severe hepatic impairment or cirrhosis, impaired renal function (eGFR <50ml/min), acute or chronic pancreatitis, gastroparesis, gallbladder disease or cholelithiasis, other severe gastrointestinal disease, heart failure, coronary artery disease, stroke, seizure disorder, or other medical condition that poses a risk for the medication or alcohol administration components of the study (as determined by the MD) A personal or family history of medullary thyroid cancer or multiple endocrine neoplasia 2A or 2B Calcitonin greater than or equal to 50 ng/L Uncontrolled thyroid disease at screening History of major surgical procedures involving the stomach potentially affecting absorption of trial product (e.g., subtotal and total gastrectomy, sleeve gastrectomy, gastric bypass surgery) History of Type 1 or Type 2 diabetes, or HbA1c >6.5% measured at screening History of diabetic retinopathy, proliferative retinopathy, or maculopathy History of diabetic ketoacidosis History or presence of malignant neoplasms within the last 5 years (except basal and squamous cell skin cancer and carcinoma in situ) Currently nursing, pregnant, anticipating pregnancy in the next 6 months, or not using a highly effective contraceptive method as judged by the MD, and defined as: combined (estrogen and progestogen containing) hormonal contraception associated with inhibition of ovulation (oral, intravaginal, transdermal) progestogen-only hormonal contraception associated with inhibition of ovulation (oral, injectable, implantable) intrauterine device intrauterine hormone-releasing system bilateral tubal occlusion vasectomized partner sexual abstinence Elevation of serum lipase, amylase, direct (conjugated) bilirubin, or alkaline phosphatase (ALP), ALT, or AST) more than 3X the upper limit of normal on baseline bloodwork Baseline body mass index (BMI) <23kg/m^2 Uncontrolled hypertension or systolic BP >180 mmHg and/or diastolic BP >105 mmHg, averaged from three measurements Plans for travel outside of the local area in the upcoming 12 weeks that would interfere with lab visits during the study period (or other logistic factors that would make it difficult to commit to entire duration of study)

Ages Eligible for Study
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Minimum Age: 21 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Randomized parallel group design.
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Semaglutide<br>Participants will receive semaglutide via subcutaneous injections at escalating doses (.25mg to 1.0mg) over 9 weeks. | Drug: Semaglutide<br>* Semaglutide (subcutaneous)<br>|
| Sham Comparator: Sham/Placebo<br>Participants will receive sham subcutaneous injections over 9 weeks. | Drug: Sham/placebo<br>* Sham subcutaneous injection<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Volume of Alcohol Consumed | Volume of alcohol consumed during a self-administration procedure | baseline (Week 0) to post-medication (Week 8) | 
| Change in Breath Alcohol Concentration | Peak breath alcohol concentration during a self-administration procedure | baseline (Week 0) to post-medication (Week 8) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Subjective Stimulation from Alcohol (Biphasic Effects of Alcohol questionnaire) | Seven questions from the Biphasic Effects of Alcohol questionnaire used to collect self-reported feelings of stimulation during an alcohol challenge procedure. Possible responses are 0-10, 0 being not at all and 10 being extremely. Scores range from 0 to 70. Higher scores indicate more stimulation effects. | baseline (Week 0) to post-medication (Week 8) | 
| Change in Subjective Sedation from Alcohol (Biphasic Effects of Alcohol questionnaire) | Seven questions from the Biphasic Effects of Alcohol questionnaire used to collect self-reported sedative feelings during an alcohol challenge procedure. Possible responses are 0 not at all through 10 extremely. Scores range from 0 to 70. Higher scores indicate more sedative effects. | baseline (Week 0) to post-medication (Week 8) | 
| Change in Alcohol Demand (Alcohol Purchase Task) | The Alcohol Purchase Task is a 20-question self-reported measure to understand motivation for obtaining alcohol which asks participants about the number of drinks they would purchase and consume based on an increasing drink cost. | baseline (Week 0) to post-medication (Week 8) | 
| Change in Cigarette Demand (Cigarette Purchase Task) | Self-reported cigarette demand during an alcohol challenge procedure | baseline (Week 0) to post-medication (Week 8) | 
| Change in Daily Alcohol Use (Timeline Followback questionnaire) | Self-reported drinks per day | baseline (Week 0) to study endpoint (Week 10) | 
| Change in Daily Cigarette Use (Timeline Followback questionnaire) | Self-reported cigarettes per day | baseline (Week 0) to study endpoint (Week 10) |