Glucagon-like peptide 1 receptor agonists in substance use disorders: A systematic review of ClinicalTrials.Gov.
This systematic review surveyed ClinicalTrials.gov (from inception through July 2025) to map the landscape of registered clinical trials investigating glucagon-like peptide-1 receptor agonists (GLP-1RAs) as potential treatments for substance use disorders (SUDs). Of 192 records identified, 33 trials met inclusion criteria. The most commonly studied SUD was alcohol use disorder (15 trials), followed by nicotine/tobacco (9), cocaine (4), opioid (4), and methamphetamine (1); no trials targeting cannabis use disorder were identified. Agents under investigation included semaglutide, exenatide, tirzepatide, liraglutide, dulaglutide, and pemvidutide. The review found that trial designs and outcome measures were highly heterogeneous, often blending self-reported measures (e.g., Timeline Follow-Back, craving scales) with objective indices (e.g., urine toxicology). The authors note that most registered trials rely on older-generation GLP-1RAs and that significant gaps exist for methamphetamine and cannabis use disorders. As a registry-based systematic review, it does not report clinical efficacy data from completed trials. The authors conclude that next-generation GLP-1RAs and trials using FDA-recommended endpoints are needed to establish efficacy and safety across the full spectrum of SUDs.
Why this grade: This is a systematic review of registered trial protocols on ClinicalTrials.gov rather than a synthesis of completed trial outcome data, so it cannot provide direct evidence of GLP-1RA efficacy or safety in humans with SUDs.
Background Substance use disorders (SUDs) are widely prevalent and associated with high morbidity and mortality. Current treatments have limited efficacy and there are no United States Food and Drug Administration (FDA)-approved treatments for several SUDs (such as methamphetamine, cocaine, and cannabis use disorders). Emerging evidence suggests glucagon-like peptide 1 receptor agonists (GLP-1RAs) may improve outcomes related to SUD. Therefore, a systematic survey of ongoing clinical trials that are evaluating the effects of GLP-1RAs for SUDs is warranted. Methods We searched ClinicalTrials.gov from inception to July 2, 2025 (preregistered at: https://osf.io/x58ne/). Inclusion required a GLP-1RA intervention targeting SUDs and outcomes regarding substance use (e.g., urine toxicology, Timeline Follow-Back, craving). Trials excluding individuals with SUDs were excluded. Results Of 192 records, 33 met criteria: alcohol use disorder (n = 15), nicotine/tobacco (n = 9), cocaine (n = 4), opioid (n = 4), methamphetamine (n = 1), and none for cannabis. Agents studied included semaglutide (n = 15), exenatide (n = 8), tirzepatide (n = 6), liraglutide (n = 2), dulaglutide (n = 1), and pemvidutide (n = 1). Outcomes and designs were heterogeneous and often mixed self-report with objective indices. Most studies used older GLP-1RAs, focused mainly on alcohol or nicotine/tobacco use disorder, and used a range of outcome measures relying on self-reported and objective measures of substance use. Conclusions While GLP-1RAs may represent a paradigm shift for treating SUD, current trials have focused on alcohol and nicotine/tobacco use disorders, with notable gaps for methamphetamine and cannabis use disorders. Trials testing next-generation GLP-1RAs with FDA recommended endpoints are needed to define efficacy and safety across SUDs.
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