GLP-1 Receptor Agonist Therapy and Surgical Procedure Rates in Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) is a chronic inflammatory disease marked by painful nodules, abscesses, and sinus tracts, often requiring interventions such as incision and drainage (I&D) or wide local excision (WLE). These procedures, common in moderate to severe cases, are invasive and prone to recurrence, underscoring the need for therapies that reduce surgical burden. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) exhibit anti-inflammatory and immunomodulatory properties, with emerging evidence suggesting potential benefits for HS. The objective was to evaluate the impact of GLP-1 RA therapy on surgical outcomes in patients with HS using population-level data. A retrospective, propensity score–matched cohort analysis was performed on TriNetX comparing rates of HS-related surgical procedures in patients treated with GLP-1 RAs versus matched controls. Patients were 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 CPT codes. Odds ratios with 95% confidence intervals were included to compare the incidence of surgical intervention between groups. Simple I&D was performed in 5.68% of GLP-1 RA users versus 6.54% of controls, while complicated I&D occurred in 2.38% versus 2.82%. Rates of WLE were also significantly lower in the GLP-1 RA group, including axillary excision, inguinal excision, and perineal or umbilical excision. GLP-1 RA use is associated with a significantly reduced need for surgical interventions, highlighting a possible disease-modifying effect in HS. While surgery may offer remission, it may not be suitable or preferred by all patients, and GLP-1 RAs may require ongoing use and incur long-term costs. Prospective trials are needed to confirm these findings, clarify cost-effectiveness, optimal duration, and patient selection, and to compare outcomes with surgical approaches.