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GLP-1 receptor agonists show early promise for psoriasis and HS, but 3 experts urge caution on mechanism, durability, and long-term safety.
GLP-1 receptor agonists, known primarily for their use among individuals with obesity, overweight, and diabetes, are increasingly being explored for their potential role in dermatology.1,2,3
The HCPLive editorial team spoke with 3 clinicians working in dermatology: Neal Bhatia, MD, the former vice president of the American Academy of Dermatology (AAD), Shanthi Narla, MD, an assistant professor of dermatology at the Medical College of Wisconsin known for her research on the intersection of GLP-1 receptor agonists in dermatology, and Samip Sheth, MD, a dermatology resident and co-author of a recent JAMA paper on the topic.4,5
Sheth, Narla, and Bhatia all spoke with HCPLive about their views on this topic, as well as available evidence for GLP-1 implementation and concerns over the use of weight loss drugs for diseases such as psoriasis, hidradenitis suppurativa (HS), and other skin conditions. Their views help to encapsulate the current conversation on GLP-1 use in the dermatology space, with each having presented upon the topic or written about it in their recent publications.
In Sheth's JAMA paper, his team highlighted psoriasis severity reductions of approximately 40% - 80% when GLP-1s are added to existing drugs or implemented alone in individuals with obesity or type 2 diabetes. A separate trial combining a GLP-1 agonist with an interleukin (IL)-17 inhibitor showed greater levels of skin clearance alongside weight loss. Such findings, he stated, reinforced interest in combination approaches.
Nevertheless, questions remain about the medications’ mechanism. Narla expressed her own view that most existing research has yet to isolate GLP-1 therapy, making it difficult to determine how much of the drugs’ benefits stems from weight loss as opposed to potentially direct anti-inflammatory impacts. In his interview, Sheth described mechanistic data supporting the latter, pointing to GLP-1 receptors’ existence on immune cells and noting that the drugs have been shown to lead to inflammatory marker reductions. Specifically, he highlighted CRP, TNF-alpha, and IL-6.
Despite the momentum, all 3 of the speakers expressed their own level of cautious optimism. In speaking about concerns related to GLP-1 use, Bhatia warned against unregulated or compounded GLP-1 products and their risks, especially given the seeking of access among patients outside standard prescribing channels. Both Sheth and Narla also flagged disease improvement as potentially reversable if patients on these therapies discontinue their use.
The dermatologists also pointed to most trials on GLP-1 use in dermatology as spanning only a few months in length, leaving questions related to their long-term safety and durability somewhat unanswered. Access as well as cost were additionally described as key issues faced by patients, with all 3 physicians highlighting concerns related to incosistent insurance coverage depending on one’s indication.
At the present moment, many physicians view GLP-1s as a promising adjunctive tool as opposed to a standalone solution for dermatologic diseases, and the speakers described their view regarding this form of medication as a tool probably requiring collaboration between dermatology, endocrinology, and primary care as the available evidence for its use continues to expand.
Disclosures: Sheth and Narla had no relevant disclosures of note. Bhatia has reported serving as an advisor, consultant, and investigator for AbbVie, Almirall, Arcutis Biotherapeutics, Beiersdorf, Biofrontera, Boehringer Ingelheim, Bristol Myers Squibb, Cara Therapeutics, Dermavant Sciences, EPI Health, Ferndale, Galderma, Incyte, ISDIN, Johnson & Johnson, La Roche-Posay, LEO Pharma, Lilly, Ortho Dermatologics, Pfizer, Regeneron Pharmaceuticals, Sanofi, Sun Pharma, and Verrica Pharmaceuticals.
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