Decreased incidence of acanthosis nigricans in patients with obesity taking GLP-1 agonists

Summary: Abstract Body: This retrospective cohort study evaluates whether patients with obesity taking GLP-1 agonists have decreased incidence of acanthosis nigricans compared to matched controls taking metformin, a common systemic treatment for AN. Insulin resistance and subsequent hyperinsulinemia have been shown to be linked to the epithelial changes characteristic of obesity-associated AN. TriNetX data between 2005 and 2025 was used to analyze the risk of developing AN after an obesity diagnosis and starting an insulin sensitizer, either a GLP-1 agonist or metformin. Metformin has previously been shown to be effective in AN prevention which informed this study’s comparison against the newest generation of insulin sensitizers, GLP-1 agonists. Patients were stratified by BMI into obese (BMI 30-40) and severely obese (BMI >40) groups. Analyzed cohorts were propensity matched to control for sex, current age, isotretinoin use, insulin use, and type 2 diabetes diagnosis. Patients diagnosed with AN and with a BMI >=30 were included. Patients with rare diseases that have been demonstrated to lead to AN, with conditions that are contraindicated for GLP-1 agonist use, or with an AN diagnosis prior to starting an insulin sensitizer were excluded. Risk ratios were calculated and evaluated for statistical significance. Patients with BMI 30-40 (n=348,372) showed 38.5% reduced risk of developing AN after starting GLP-1 agonists (RR=0.615, 95% CI=(0.578, 0.654)) and patients with BMI >40 (n=191,456) showed 29.8% reduced risk of developing AN after starting GLP-1 agonists (RR=0.702, 95% CI=(0.655, 0.752)). The ages of each cohort were 54.7±14.8 (BMI 30-40) and 52±17 years (BMI >40). Both sets of cohorts were predominantly female (67-69%). This study demonstrates that GLP-1 agonist use is associated with lower incidence rate of acanthosis nigricans in obese patients compared to matched controls taking metformin. Future studies can further evaluate this association in an experimental setting. Joshua D. Bearss¹, Jack Woll¹ 1. University of California Irvine School of Medicine, Irvine, CA, United States. Clinical Research: Epidemiology and Observational Research