HS Symptoms Eased by Semaglutide-Aided Weight Loss

People with hidradenitis suppurativa (HS) who have overweight or obesity may benefit from adjunctive treatment with the glucagon-like peptide 1 (GLP-1) receptor agonist semaglutide (Ozempic, Wegovy), suggests research presented at the annual meeting of the European Academy of Dermatology and Venereology (EADV). 
In a small, nonrandomized, observational, retrospective study, semaglutide-aided weight loss was found to not only be associated with improvements in the study participants’ dermatology-related quality of life as determined by the Dermatology Life Quality Index (DLQI) but also to reduce the frequency of HS flares.
“These are very preliminary data that show that there are improvements in both objective and subjective measures,” study investigator and consultant dermatologist Daniel Lyons, of the Department of Dermatology, St. Vincent’s University Hospital in Dublin, Ireland, told Medscape Medical News.
A large randomized controlled trial in people with HS would be needed to confirm the findings, Lyons said. And although the use of semaglutide in people with HS is off-label, these early findings should provide reassurance to dermatologists that semaglutide may be beneficial and perhaps encourage them to prescribe it to appropriate patients. 
“Obesity has a known association with HS,” Lyons explained. Obesity can increase the amount of inflammation, which in turn may worsen a person’s condition Although weight loss is part of the holistic management plan for someone with HS, it can be difficult for some to achieve. 
With data from trials such as the recent STEP 5 trial showing that semaglutide could help individuals with obesity who do not have diabetes lose weight, Lyons and associates wanted “to see whether the known weight reduction effects from semaglutide would work in our patients too.” There were also data from a small case series with another GLP-1 receptor agonist, liraglutide (Victoza, Saxenda), showing a potential benefit in patients with HS and obesity. 
Study Details
The study was a retrospective analysis of 30 individuals with HS seen between June 2020 and March 2023 who had been treated with semaglutide. 
Twenty-seven women and three men (mean age, 42 years) were included in the analysis. The majority had moderate (Hurley stage II, 50%) or severe (Hurley stage III, 36%) HS. All had been receiving some form of medical treatment for HS for an average of 14.9 months, which included treatment with antibiotics, biologics, steroids, and metformin. Ten patients were taking combinations of agents. The exact regimens used were reported separately in a research letter published in the British Journal of Dermatology.
In the interview, Lyons noted that study participants had been taking Ozempic, which is the licensed formulation for type 2 diabetes, rather than Wegovy, which is the licensed formulation for obesity management. 
In Ireland, semaglutide is licensed for use in patients with diabetes and is reimbursed for that patient group, but, he said, “most of the patients we retrospectively analyzed did not have diabetes, so therefore they had to pay for [it] themselves.” This could be a limiting factor to its wider use, he acknowledged. 
Semaglutide was used for a mean duration of 8.2 months, at a mean dosage of 0.8 mg/wk. This is lower than the semaglutide dosage recommended for weight loss, which is 2.4 mg/wk. 
Weight Loss and HS Benefits
Despite the use of a low dose, mean body weight fell from a starting point of 117.7 kg to 111.6 kg during semaglutide use in the group as a whole (P <.0001). Although mean body mass index did not statistically significantly decrease from baseline to 8.9 months (43.1 vs 41.5), there was a trend toward improvement.
But it was the possible benefits on HS itself that Lyons and collaborators found most interesting. The mean DLQI score before semaglutide treatment was 13 out of a possible 30 points, indicating that HS was having a large effect on the patients’ lives. During treatment, however, the mean DLQI score was reduced to 9 out of 30 points, suggesting a more moderate effect of HS. Notably, one third of patients were found to have a reduction of 4 or more points on the DLQI, which is considered as the minimal clinically important difference for this index, Lyons and his co-authors said in their research letter.
And although not statistically significant, there was an improvement in the frequency of patient-reported HS flares. The mean frequency of flares decreased from once every 8.5 weeks to once every 12 weeks.
There was also a trend toward reductions in inflammatory markers, such as C-reactive protein levels and white blood cell counts, during semaglutide treatment. 
Practical Perspective
Commenting on the study for Medscape Medical News Anastasia Therianou, MD, PhD, who sits on the EADV’s Communication Committee, said, “It’s still early days. When people come to us to treat their HS, we have to offer established treatments. Semaglutide is a medication that is quite expensive, and it is not part of guidelines” for HS treatment. 
“Currently, I wouldn’t recommend this to my patients, because we need to see more studies,” added Therianou, a consultant dermatologist for Imperial College Healthcare NHS Trust and is also in private practice in London, England. 
Although there may be an adjunctive role for semaglutide to aid weight loss in future, Therianou said that she needed to see more evidence that there was a benefit on HS directly. 
People with HS can experience pain from boils or inflammation under their arms, in the groin, or the area around the buttocks, she noted, which is why an effect on quality of life is important. Even with weight loss alone, there may not be much of an improvement. However, Therianou said that the results of the study showed that semaglutide “improves the boils, the inflammation. So, this means that it decreases the pain and improves the quality of life of the patient,” which could be important.
The study received no commercial funding. Lyons and Therianou report no relevant financial relationships. 
Sara Freeman is a freelance medical journalist based in London, England. 
 
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