Early Initiation of Adalimumab for Hidradenitis Suppurativa May Improve Treatment Response

Hidradenitis suppurativa
Hidradenitis suppurativa
Adalimumab provided significant improvement in patients with HS and possesses a good safety profile, which should encourage early use of this treatment to better control disease progression.

In patients with moderate to severe hidradenitis suppurativa, response to adalimumab may be improved with early administration, study research published in the British Journal of Dermatology suggests.

A total of 389 patients treated with adalimumab for moderate to severe hidradenitis suppurativa from 21 centers across Italy were enrolled. Patients had disease that was resistant to standard first-line treatment. Several patient data were assessed, including smoking prevalence, ages at onset/diagnosis/baseline, phenotypes, prior treatments, concomitant antibiotics, and therapeutic delay.

The therapeutic delay endpoint was defined as the time from onset of disease to initiation of adalimumab. Hidradenitis Suppurativa Clinical Response (HiSCR) and Dermatology Life Quality Index (DLQI)/visual analog scale for pain (VAS pain) were used to evaluate adalimumab response and the impact of the therapy on quality of life.

There was a 10-year median therapeutic delay in the cohort. Based on the HiSCR, clinical response to adalimumab was 43.7% at week 16 and 53.9% at week 52. Therapeutic delay significantly correlated with nonresponse to adalimumab at week 16 (odds ratio [OR], 1.92 for therapeutic delay ≥10 years; 95% CI, 1.28-2.89; P =.0016) and at week 52 (OR, 1.60; 95% CI, 1.01-2.53; P =.0435).

The researchers also observed significant reductions in DLQI scores between 16 weeks vs baseline (P <.0001), 52 weeks vs baseline (P <.0001), and 52 weeks vs 16 weeks (P <.0001). In addition, there was a significant inverse correlation between previous systemic immunosuppressive/immunomodulating agents with HiSCR at 52 weeks (OR, 1.74; 95% CI, 1.04-2.91; P =.0342).

Limitations of the study included its observational and retrospective design as well as the inclusion of only patients with moderate to severe hidradenitis suppurativa that was resistant to first-line treatment.

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Based on these findings, the researchers wrote that “using adalimumab in early phases of hidradenitis suppurativa should be highly encouraged.”

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Marzano AV, Genovese G, Casazza G, et al. Evidence for a “window of opportunity” in hidradenitis suppurativa treated with adalimumab: a retrospective, real-life multicenter cohort study [published online March 2, 2020]. Br J Dermatol. doi: 10.1111/bjd.18983