Risk of Alopecia Areata with Glucagon-Like Peptide-1 Receptor Agonists for Weight Loss

GLP-1 (glucagon-like peptide-1) agonists including semaglutide are some of the most prescribed medications in the world. Many recent studies have quantified their adverse events with a focus on gastrointestinal adverse events. However, no large epidemiologic study has investigated the risk of hair loss with these medications. We conducted a retrospective cohort study using a large health claims database to investigate this risk. Using a random sample of 16 million patients, we identified new users of semaglutide and an active comparator bupropion-naltrexone. We excluded those with a diagnosis of diabetes or use of antihyperglycemics prior to cohort entry. Cohort members were followed from the first date of a study drug prescription to the diagnosis of hair loss. We adjusted for age, sex, geographic location, depression, steroid use, hypothyroidism, polycystic ovary syndrome, and anemia. Our cohort included 1,926 semaglutide users and 1,348 users of bupropion-naltrexone. The incidence of hair loss was higher among the semaglutide group than the active comparator, bupropion-naltrexone. The adjusted hazard ratio for hair loss for all patients using semaglutide, for men, and for women compared to bupropion-naltrexone were 1.52 (95% confidence interval (CI):0.86-2.69), 0.86 (95% CI: 0.05-14.49), and 2.08 (95% CI: 1.17-3.72) respectively. Our results demonstrate an increased risk of hair loss with semaglutide in women. Future studies are required to ascertain the association between semaglutide and hair loss.