Adalimumab Monotherapy Improves Hidradenitis Suppurativa Endpoints

Hidrosadenitis suppurativa
Researchers assessed the effectiveness of adalimumab monotherapy vs the traditional antibiotic combination (rifampicin and clindamycin) to treat patients with moderate to severe hidradenitis suppurativa.

Adalimumab monotherapy may reduce disease severity and improve quality of life (QoL) to a greater degree than rifampicin and clindamycin combination therapy in patients with hidradenitis suppurativa (HS), according to study findings published in the Journal of Drugs in Dermatology.

Patients with moderate to severe HS (mean[1]  disease duration, 6.8 years) who attended an outpatient clinic in Naples, Italy, were included in a retrospective analysis. The researchers assessed disease severity using the modified Sartorious score and measured QoL with the Hidradisk score. Patients were treated with either adalimumab monotherapy (n=30; mean age, 26.2±7.25 years) or rifampicin plus clindamycin (n=30; mean age, 23.73±4.57 years). Disease severity and QoL scores were collected at baseline and after 10 weeks of treatment.

Participants in the antibiotic group started on only twice-daily rifampicin 300 mg for 7 days followed by the addition of twice-daily clindamycin 300 mg after the first week of rifampicin monotherapy. At baseline, the mean modified Sartorius score was 68.8; treatment with clindamycin plus rifampicin was associated with a significant reduction in the Sartorious score to 57.8 at 10 weeks (P =.0052). The mean Hidradisk score also decreased noticeably from baseline to 10-week follow-up (74.73 vs 62, respectively; P =.0095). A total of 10 patients achieved the criteria for an HS clinical response.

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In the adalimumab group, participants received subcutaneous injections of 160 mg adalimumab at baseline, 80 mg at week 2, 40 mg at week 4, and 40 mg per week thereafter. A greater reduction was observed in disease severity from baseline to week 10 (mean modified Sartorius score, 74.93 vs 39.86, respectively; P <.0001) compared with the antibiotic group. In addition, QoL improved at 10 weeks in the monotherapy group (mean Hidradisk value at baseline [77.73] vs week 10 [51.86]; P <.0001). A greater number of patients (n=18) achieved the HS clinical response.

Study limitations include its retrospective design and the small number of patients in each group.

“Further studies,” the researchers concluded, “involving larger groups of patients, are needed to better define these preliminary results.”

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Marasca C, Annunziata MC, Villani A, et al. Adalimumab versus rifampicin plus clindamycin for the treatment of moderate to severe hidradenitis suppurativa: a retrospective study. J Drugs Dermatol. 2019;18(5):437-438.