Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease marked by recurrent nodules, abscesses, and sinus tracts, predominantly affecting intertriginous areas such as the axillae, groin, and perineum. The disease course is often marked by progressive tissue destruction, scarring, and a significant reduction in quality of life. Surgical interventions include incision and drainage (I&D) or wide local excision (WLE). These procedures, though common in moderate to severe cases, are invasive and prone to recurrence, underscoring the need for therapies that reduce surgical burden and improve long-term outcomes [1]. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), developed for glycemic control in type 2 diabetes mellitus and more recently used for weight management in obesity, have demonstrated anti-inflammatory and immunomodulatory effects. Emerging evidence suggests that GLP1-RAs may benefit inflammatory skin conditions, including HS, by modulating cytokine profiles and immune cell function [2–4]. However, population-level data evaluating the impact of GLP-1 RA therapy on HS disease course, especially surgical outcomes, remain limited.
We performed a retrospective, propensity score–matched cohort analysis using the TriNetX Global federated network to compare the incidence of HS-related surgical procedures in patients treated with GLP-1 RAs versus matched controls. Patients with HS were identified using the International Classification of Diseases (ICD) 10 code L73.2 and matched 1:1 on age, gender, race, and ethnicity, resulting in two balanced cohorts of 20,672 patients each. Exposure to GLP-1 RAs was determined through prescription records, and surgical outcomes were identified using Current Procedural Terminology (CPT) codes. Odds ratios (ORs) with 95% confidence intervals (CIs) were included to compare the incidence of surgical intervention between groups (see Table 1).
Table 1
Case-Control Analysis of HS-Related Surgical Procedures in Patients Treated With GLP-1 RAs Versus Matched Controls.
Outcome (CPT Code) | Case (%) (n = 20,672) | Controls (%) (n = 20,672) | OR (95% CI)† | p-value† |
|---|
Age ± SD | 44.0 +/- 13.5 | 44.0 +/- 13.5 | - | 0.915 |
White | 11,419 (55.2%) | 11,424 (55.3%) | - | 0.961 |
American Indian or Alaska Native | 164 (0.8%) | 152 (0.7%) | - | 0.498 |
Female | 16,938 (81.9%) | 16,957 (82.0%) | - | 0.808 |
Native Hawaiian or Other Pacific Islander | 159 (0.8%) | 140 (0.7%) | - | 0.27 |
Not Hispanic or Latino | 14,226 (68.8%) | 14,239 (68.9%) | - | 0.791 |
Hispanic or Latino | 2,028 (9.8%) | 2,012 (9.7%) | - | 0.89 |
Black or African American | 6,486 (31.4%) | 6,499 (31.4%) | - | 0.89 |
Male | 3,721 (18.0%) | 3,706 (17.9%) | - | 0.848 |
Asian | 376 (1.8%) | 371 (1.8%) | - | 0.854 |
Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single (10060) | 1174 (5.7%) | 1352 (6.5%) | 0.86 (0.79, 0.93) | 0.0003* |
Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); complicated or multiple (10061) | 491 (2.4%) | 582 (2.8%) | 0.84 (0.74, 0.95) | 0.0049* |
Excision of skin and subcutaneous tissue for hidradenitis, axillary (1003234) | 234 (1.1%) | 410 (1.9%) | 0.56 (0.48, 0.67) | < 0.0001* |
Excision of skin and subcutaneous tissue for hidradenitis, inguinal (1003237) | 150 (0.7%) | 240 (1.2%) | 0.62 (0.51, 0.75) | < 0.0001* |
Excision of skin and subcutaneous tissue for hidradenitis, perianal, perineal, or umbilical (1003240) | 110 (0.5%) | 215 (1.04%) | 0.51 (0.40, 0.64) | < 0.0001* |
| † Reported data are after performing a propensity-matched analysis. |
| * Statistically significant data indicated by p < 0.05. |
Surgical interventions related to HS were significantly less common in patients treated with GLP-1 RAs compared to controls. Simple I&D was performed in 5.68% of GLP-1 RA users versus 6.54% of controls (OR = 0.86, 95% CI: 0.79–0.93), while complicated I&D occurred in 2.38% versus 2.82% (OR = 0.84, 95% CI: 0.74–0.95). Rates of WLE were also significantly lower in the GLP-1 RA group, including axillary excision (1.13% vs. 1.98%; OR = 0.57, 95% CI: 0.48–0.67), inguinal excision (0.73% vs. 1.16%; OR = 0.62, 95% CI: 0.51–0.76), and perineal or umbilical excision (0.53% vs. 1.04%; OR = 0.51, 95% CI: 0.40–0.64) (see Table 1).
Our large, multicenter analysis demonstrates that treatment with GLP-1 RAs is associated with a significant reduction in the frequency of surgical interventions for patients with HS. The magnitude of effect was most pronounced for WLEs (i.e., perianal, perineal, and umbilical), where GLP-1 RA use was associated with nearly a 50% reduction in surgical burden (see Fig. 1). Surgical management of HS, while often necessary, is associated with postoperative complications, prolonged recovery periods, and substantial healthcare costs [1]. By potentially reducing the frequency and necessity of surgical interventions, GLP-1 RA therapy may improve patient quality of life and decrease healthcare resource utilization.
Metabolic dysregulation, including obesity and insulin resistance, has been implicated in the pathophysiology of HS, with obesity being a well-established risk factor for increased disease severity and persistence [1]. GLP-1 RAs, like liraglutide, improve glycemic control and induce weight loss by enhancing glucose-dependent insulin secretion and reducing appetite. Liraglutide has demonstrated anti-inflammatory properties via the suppression of tumor necrosis factor alpha (TNF-α), nuclear factor-kappa B (NF-κB), and other pro-inflammatory cytokines such as IL-17, IL-22, and IL-23, which are implicated in the pathophysiology of HS [1–4]. These anti-inflammatory properties, combined with demonstrated metabolic effects, position GLP-1 RA therapy as an effective disease-modifying strategy that may address underlying metabolic dysfunction, chronic systemic inflammation, and decrease disease severity [2–5]. Recent case series suggest similar findings and report clinical improvement in HS patients treated with GLP1-RAs, including reductions in lesion count, pain, and flare frequency [6].
The retrospective study design and reliance on administrative coding introduce potential limitations, including misclassification bias and residual confounding, despite propensity matching. Detailed clinical data on HS severity (i.e., Hurly stage), duration of GLP-1 RA therapy, adherence, and concomitant treatments were not available. Therefore, the ability to perform dose-response or temporal analyses was limited. Carbon dioxide (CO2) laser procedures were also excluded from analysis due to limitations in CPT coding specificity. Future studies should incorporate these interventions, as they are an important and expanding component of HS surgical care.
Further research is needed to evaluate the cost-effectiveness of GLP-1 RAs. Surgical procedures, particularly WLEs, can be remittive for some patients, potentially offering long-term or permanent disease control. In contrast, GLP-1 RAs may require ongoing administration, which could result in substantial cumulative costs and may not induce remission. The optimal duration of GLP-1 RA therapy for HS also remains unclear as it is not yet known whether these agents are needed long-term to sustain benefit or if a finite course can achieve significant disease modification.
Additionally, it is important to recognize that not all patients are candidates for or desire surgery due to its invasiveness, associated risks, and impact on quality of life. Some patients may elect to pursue less invasive medical management options. The availability of effective non-surgical therapies such as GLP-1 RAs may expand the range of treatment choices, supporting a more individualized and patient-centered approach to HS care. Therefore, future studies should assess the long-term efficacy and cost-benefit profile of GLP-1 RA therapy with respect to patient-reported outcomes and satisfaction across different management strategies.
Our findings support and extend prior studies by demonstrating, at population scale, that GLP-1 RA use is associated with a significantly reduced need for surgical interventions. This suggests symptomatic improvement and a measurable decrease in surgical disease burden, highlighting a possible disease-modifying effect of GLP-1 RA therapy in HS. Prospective, randomized controlled trials are needed to confirm these observational findings, elucidate the pathophysiologic mechanisms underlying GLP-1 RA efficacy in HS, and define optimal dosing and patient selection criteria. Additionally, investigating the synergistic effects of GLP-1 RAs with biologic medications such as adalimumab or secukinumab may further enhance therapeutic outcomes.