GLP-1s tied to sharply lower death, systemic risk in hidradenitis suppurativa

Clinical takeaway: For patients with hidradenitis suppurativa who already qualify for a GLP-1 on cardiometabolic grounds, these findings suggest significant added upside.

Hidradenitis suppurativa clusters with obesity and metabolic disease and carries a well-documented excess risk of cardiovascular disease and early death, yet clinicians have had few tools that touch that systemic burden. A new retrospective cohort analysis links GLP-1 use in these patients to substantially lower all-cause mortality, alongside fewer cardiovascular events and serious infections.

GLP-1s have moved well past their initial glycemic-control orientation, with cardiovascular outcome trials showing mortality benefit and growing evidence of anti-inflammatory effects across a range of conditions. That raises an obvious question in an inflammatory skin disease like HS: whether the drugs might also blunt the systemic risk it carries.

Use of GLP-1s was linked to a 71% lower risk of all-cause mortality at one year, and the association held at two years, when mortality was 64% lower. At one year, major adverse cardiovascular events, a composite of cardiovascular death, nonfatal MI, and nonfatal stroke, were 30% lower. The reductions at one year extended to other common HS complications and co-occurring issues: dialysis initiation (67%), suicidal ideation or attempts (54%), sepsis (45%), cellulitis (34%), and acute kidney injury (33%). Associations were consistent across one- and two-year follow-up.

The analysis used electronic health records to compare adults with HS who filled at least two GLP-1 prescriptions against those who filled none, matching roughly 20,000 patients per group on age, sex, race, and major comorbidities. The associations held in patients without diabetes and pointed the same direction in those without obesity, though the no-obesity subgroup was not statistically significant. The study tracked systemic complications rather than skin disease itself, so does not address lesion control.

The analysis pooled all GLP-1 agents without distinguishing newer drugs like semaglutide and tirzepatide from older ones, so the class-level estimate may blur real differences between agents. Follow-up ran only two years in a relatively young, mostly female cohort at low baseline cardiac risk, which likely limited the number of cardiovascular events captured.

The pattern here is hard to explain by weight loss alone. Benefit appeared in patients without diabetes and trended the same way in those without obesity, and it spanned outcomes as varied as cardiovascular events, serious infection, and kidney injury. That breadth fits the idea that GLP-1s act on the systemic inflammation underlying HS, though a retrospective design cannot separate drug effect from the possibility that patients with better access to care, and the cardioprotective treatment that comes with it, were the ones getting prescriptions.

"These results suggest a potential adjunctive role of this drug class in managing HS and its comorbidities and potentially improving overall health and mortality," wrote Haley Naik, M.D., M.H.Sc., associate professor of dermatology, and Diana Thiara, M.D., associate professor of medicine, both at the University of California, San Francisco, in an accompanying editorial.

Source: Jastrząb-Miśkiewicz B, et al. (2026 Jul 1) JAMA Dermatol. GLP-1 receptor agonist use and clinical outcomes in patients with hidradenitis suppurativa