Rapid weight loss and anti-inflammatory effects reduce flares and improve quality of life, researchers say.
Glucagon-like peptide-1 receptor agonists may offer a new lifeline for patients with hidradenitis suppurativa, according to researchers.
The French study found GLP-1 RAs could significantly reduce disease activity, flares, pain and quality-of-life impairment – especially in patients with obesity and diabetes.
Their findings were published this month in a research letter in JAMA Dermatology.
The chronic inflammatory skin disorder is strongly associated with overweight and obesity, affecting up to 50% of patients.
Dysfunctional adipose tissue contributes to HS pathophysiology by overproducing proinflammatory adipokines and cytokines while reducing anti-inflammatory adiponectin.
Weight loss, achieved through dietary measures or bariatric surgery, has been shown to benefit HS in many patients, but sustaining meaningful reductions remains challenging in clinical practice.
The retrospective multicentre cohort study included patients with HS exposed to GLP-1 RAs from 2017 to 2024, using data from the HS-France network and biomedical warehouses from eight French hospitals.
Adults with HS (Hidradenitis Suppurativa Physician’s Global Assessment [HS-PGA] score ≥1) confirmed by a dermatologist who were receiving GLP-1 RAs for three months or longer were included.
Outcomes assessed at initiation, six months and discontinuation or last consultation included HS-PGA, flare frequency, Numerical Rating Scale (NRS) for pain and suppuration, Dermatology Life Quality Index (DLQI) and body mass index (BMI).
Among the 66 patients, the median age was 46 years, with 58% female. Median BMI was 39.4 kg/m², and 86% had diabetes. At baseline, 53% were receiving active HS treatment, including suspensive antibiotics, broad-spectrum antibiotics or biologics.
Disease severity was distributed across Hurley stages I (45%), II (32%), and III (23%). GLP-1 RAs administered included semaglutide (48 patients), dulaglutide (13), and liraglutide (5), with a median follow-up of 18.5 months.
At six months, 54% of patients achieved a ≥1-point reduction in HS-PGA, while 12% achieved a ≥2-point reduction. Flare frequency decreased in 60%, NRS-Pain in 52%, NRS-Suppuration in 53% and DLQI in 50% of patients.
Improvements were even more pronounced at last follow-up, with 62% achieving ≥1-point HS-PGA reduction and 32% achieving ≥2 points. In the subgroup of 34 patients whose HS treatments remained unchanged for 12 months prior to M6, all outcomes demonstrated statistically significant improvement.
“The beneficial effect of GLP-1 RAs could result from a direct effect of weight loss, by reducing friction in flexural areas, maceration and obesity-related low-grade systemic inflammation, and/or an anti-inflammatory effect, lowering inflammatory cytokines and attenuating Toll-like receptor–mediated inflammation in response to bacteria,” the researchers wrote.
“Additionally, GLP-1 RAs can promote skin healing by reducing matrix metalloproteinases.”
Limitations of the study included the retrospective design, heterogeneity of concomitant HS treatments and the absence of detailed biological or glycaemic control data.
To mitigate this limitation the researchers focused the analysis on patients whose HS treatments remained unchanged during the previous 12 months, in whom there was a statistically significant reduction in all outcomes at month six.
Additionally, to limit selection bias related to investigator recall, they used data warehouses, which accounted for 85% of the study population.
“GLP-1 RAs offer promise for patients with HS and obesity and potentially for patients without obesity through immunological effects,” the researchers concluded.
“Randomised clinical trials are warranted to confirm the role of GLP-1 RAs in HS management.”
