Despite the availability of various pharmacological and behavioural interventions, alcohol-related mortality is rising. This systematic review aimed to critically evaluate the existing literature on the association between glucagon-like peptide-1 receptor agonists use (GLP-1 RAs) and alcohol consumption. Electronic searches were conducted on Ovid Medline, EMBASE, PsycINFO, clintrials.gov, and ProQuest until the end of March 2024. An updated search was done on 7th of August 2024. The primary outcome was to explore the association between GLP-1 RAs use and change in alcohol consumption. Secondary outcomes included evaluating the impact of GLP-1 RAs on occurrences of alcohol-related events, healthcare utilisation, and the effect on functional magnetic resonance imaging (fMRI) cue reactivity. This study is registered with PROSPERO #CRD42024531982. Six studies totalling 88,190 participants were included with 38,740 (43.9%) receiving GLP-1 RA, but only 286 participated in randomised controlled trials. Pooled mean age was 49.6 years (SD = 10.5). RCT data did not show a reduction in alcohol consumption over 30 days after 24 weeks of treatment with exenatide versus placebo (heavy drinking days 6.0 [higher in control group], 95% CI -7.4 to 19.4, p = 0.37), a subgroup analysis found a positive effect in people with obesity (BMI >30 kg/m²), with significant reductions in brain reward centre cue reactivity on fMRI. In a secondary analysis of an RCT participants taking dulaglutide compared to placebo were 29% more likely to reduce alcohol intake (relative effect size 0.71, 95% CI 0.52-0.97, p = 0.04). Observational studies showed fewer alcohol-related healthcare events and a significant reduction in alcohol use with GLP-1 RAs treatment compared to DPP4-Dipeptidyl peptidase 4 use, no treatment and/or alcohol intake at baseline. There is little high-quality evidence demonstrating the effect of GLP-1 RAs on alcohol use. Subgroup analysis from two RCTs and supporting data from four observational studies suggest that GLP-1 RAs may reduce alcohol consumption and improve outcomes in some individuals. Heterogeneous study findings warrant further research to establish the effectiveness and safety of GLP-1 RAs in this population. National Institute for Health and Care Research (NIHR): Award-ID: NIHR155469; NIHR154191; NIHR155530. NIHR Nottingham Biomedical Research Centre, Award-ID: BRC-1215-20003.

Early identification followed by effective behaviour interventions is pivotal to changing the natural history of alcohol-related liver disease. We examined the feasibility of using transient elastography based advice and alcohol recovery video stories (ARVS) to change drinking behaviour in community alcohol services. A feasibility randomised control trial (RCT) was conducted in three community alcohol services. Adults 18+ years presenting with a primary alcohol problem were randomised (1:1) to receive either usual care (control group) or usual care and the KLIFAD Intervention, consisting of advice tailored to liver stiffness measure and access to ARVS (intervention group). Data were collected at baseline and six months. To establish definitive trial feasibility, recruitment and retention rates, study procedure safety and extent of effectiveness were measured (Start date: 02.10.2019, End date: 30.11.2022, ISRCTN.com: 16922410). 382 service users were screened, 184 were randomised (intervention: 93, control: 91), and baseline data were collected for 128 (intervention: 71, control: 59). Six months follow-up data were available in 87 (intervention: 53, control: 34). Intervention compared to the control group had a longer duration of engagement with services (mean difference 8.6 days SD = 18.4), was more likely to complete the allocated treatment program and reduced or stop drinking (54.9% vs 43.9%) and reduce AUDIT category (71.7% vs 61.8%). There were no reported serious adverse reactions, one intervention group participant reported an increase in AUDIT category. Integration of transient elastography in community alcohol services is feasible. It may improve engagement with services, retention in clinical trials and supplement the reduction in self-reported alcohol consumption. A definitive RCT is supported. 10.13039/501100000272 National Institute for Health and Care Research (NIHR201146).

Background and Aims: Alcohol dependence affects over 240 million people worldwide and attributed to 3 million deaths annually. Early identification and intervention are key to prevent harm. We aim to systematically review literature on the effectiveness of adding advice based on biomarkers of liver injury or non-invasive tests of liver fibrosis (intervention-based advice) to prevent alcohol misuse. Methods: Electronic search was conducted on Ovid Medline, PubMed, EMBASE, Psychinfo and CINAHL for articles published up to end of February 2020. Additionally, we searched study citations, Scopus, Ethos and Clinical trials. The primary outcome measure was changed in self-reported alcohol consumption analysed by random-effects meta-analysis. Secondary outcomes included change to liver blood markers and alcohol-related health outcomes. Results: Fourteen randomized controlled trials (RCTs) and two observational studies comprising n = 3763 participants were included. Meta-analyses showed a greater reduction in alcohol consumption and liver biomarkers for the intervention compared to control group: mean difference for weekly alcohol intake was −74.4 g/week (95% confidence interval (CI) −126.1, −22.6, P = 0.005) and mean difference for gamma-glutamyl transferase (GGT) −19.7 IU/l (95% CI −33.1, −6.4, P = 0.004). There was a higher incidence of alcohol-attributed mortality, number of days spent in the hospital, physician visits and sickness absence in the non-intervention group. The quality of the included studies was moderate for RCTs and high for observational studies. Conclusions: The review confirmed a significant association between the addition of intervention-based advice in routine care to the reduction of harmful alcohol consumption, GGT and alcohol-related mortality. The findings support the inclusion of this type of advice in routine alcohol care.

Historically, bleeding was thought to be a frequent and fatal complication of liver disease. However, thrombosis due to coagulation disorders in cirrhosis remains a real risk. We aim to systematically analyse published articles to evaluate epidemiology of venous thromboembolism (VTE) in chronic liver disease (CLD). Electronic search was conducted on Ovid Medline, EMBASE and Scopus from inception to November 2021 to identify studies presenting epidemiology VTE (deep vein thrombosis and pulmonary embolism) in CLD in inpatients and/or community settings. Random-effects meta-analysis was performed to determine pooled per-year cumulative incidence, incidence rate and prevalence. Heterogeneity was measured by I² test, and, potential sources of heterogeneity by meta-regression and sensitivity analysis. PROSPERO registration-CRD42021239117. Twenty-nine studies comprising 19,157,018 participants were included, of which 15,2049 (0.79%) had VTE. None of the included studies were done in the community. In hospitalised patients with CLD: pooled cumulative incidence of VTE was 1.07% (95% CI 0.80,1.38) per-year, incidence rate was 157.15 (95% CI 14.74,445.29) per 10,000 person-years, and period prevalence was 1.10% (95% CI 0.85,1.38) per year. There was significant heterogeneity and publication bias. Pooled relative risk (RR) of studies reporting incidence rate was 2.11 (95% CI 1.35,3.31). CLD patients (n = 1644), who did not receive pharmacological prophylaxis were at 2.78 times (95% CI 1.11, 6.98) increased risk of VTE compared to those receiving prophylaxis. Hospitalised patients with CLD may be at an increased risk of VTE. For every 1000 hospitalised patients with CLD ten have new, and eleven have pre-existing diagnoses of VTE per-year.

Alcohol use disorder (AUD) is a major global health burden with high relapse rates and limited treatment uptake. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), developed for type 2 diabetes and obesity, may also reduce alcohol consumption by modulating central reward pathways. We performed a systematic review and meta-analysis following PRISMA guidelines (PROSPERO CRD420251009075). Randomized controlled trials (RCTs) and observational studies were included if they assessed the effect of GLP-1 RAs on alcohol-related outcomes in adults with hazardous drinking or AUD. The search covered all databases from inception to June 1, 2025. The primary outcome was change in Alcohol Use Disorders Identification Test (AUDIT) scores (range 0–40), a validated screening tool assessing hazardous use, dependence, and alcohol-related harm. Alcohol use was defined as self-reported consumption (drinks or units per week, grams per day), with thresholds for risky drinking determined by study-specific definitions (e.g., ≥14 drinks/week for men, ≥7 for women). Secondary outcomes included relapses, abstinence, alcohol-related diagnoses, intoxication or hospitalization, biomarkers (e.g., phosphatidylethanol [PEth], γ-GT), and neuroimaging measures of craving, reward, and cue-reactivity. Fourteen studies (four RCTs, ten observational; n = 5,262,268) were included. GLP-1 RAs studied were Semaglutide, liraglutide, dulaglutide, exenatide, and tripeptide. Pooled analysis demonstrated a significant reduction in AUDIT scores (mean difference −7.81 points; 95% CI −9.02 to −6.60; I² = 87.5%). RCTs also reported reduced drinking days, units per drinking day, and cravings particularly with Semaglutide. GLP-1 RA use was associated with reduced alcohol intake, relapse rates, and incidence of alcohol-related diagnoses, especially in individuals with type 2 diabetes or obesity prescribed Semaglutide or liraglutide. Population-based studies showed lower risks of incident and recurrent AUD, intoxication, and hospitalization. Biomarker analyses (PEth, γ-GT) demonstrated reductions with GLP-1 RA use, and neuroimaging studies reported attenuated alcohol cue reactivity and dopaminergic signaling. Weight loss and metabolic improvements reinforced abstinence and treatment adherence. GLP-1 RAs, particularly Semaglutide and liraglutide, reduce alcohol use as measured by AUDIT scores and show beneficial effects on consumption, relapse, and alcohol-related morbidity. Mechanistic evidence supports modulation of craving and reward pathways. These findings suggest that GLP-1 RAs are promising candidates for repurposing in AUD management, especially for patients with comorbid diabetes or obesity. Large, dedicated RCTs are needed to confirm efficacy and define optimal therapeutic strategies. No funding was received for this study.

Introduction: Alcohol‐related liver disease (ARLD) is a preventable cause of mortality. Historical epidemiological studies on ARLD often lack a detailed linked assessment of health‐related contacts prior to death which limits understanding of opportunities for intervention. We aimed to analyse retrospective population‐based data of all adult residents of Nottinghamshire dying from ARLD to determine the factors associated with delayed diagnosis of ARLD and the potential missed opportunities for interventions.Methods: We linked the Office for National Statistics and Hospital Episode Statistics databases to identify adult (≥18 years) residents of Nottinghamshire, who died of ARLD over the 5‐year period (1 January 2012 to 31 December 2017). Death was used as the primary outcome, and logistic regression analysis was conducted to test the association between key variables and mortality due to ARLD.Results: Over 5 years, 799 ARLD deaths were identified. More than half had no diagnosis or a diagnosis of ARLD less than 6 months before death. Emergency presentation at first ARLD diagnosis and White ethnicity were significantly associated with a delay in diagnosis. Overall, the cohort had a median of five hospital admissions, four accident and emergency attendances and 16 outpatient appointments in the 5 years before death. Treatment was provided by a range of specialities, with general medicine the most common. Alcohol was associated with most admissions.Discussion and Conclusions: This study identified deficiencies in ARLD secondary care and provides us with a powerful methodology that can be used to evaluate and improve how alcohol issues are managed and where action can be best targeted.