Acne

Infliximab Promising in Patients With Hidradenitis Suppurativa

Ron Goldberg
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No single treatment for HS is effective in eradicating disease or preventing progression, but early recognition and treatment are critical to preventing further progression to severe disease that can have an impact on quality of life.8 Therapeutic goals for stage 1 HS in young patients are to reduce pain and inflammation and prevent scarring and disease progression through multimodal management. Topical disinfectants are generally considered ineffective.4 Topical antibiotics are the therapy of choice for mild-to-moderate disease, with the introduction of oral antibiotics where topical formulations are inadequate.4 Once the disease has progressed, biologic disease modifying antirheumatic therapies, laser therapy, and surgery may have some benefit.8 Evidence supporting the use of intravenous infliximab in Hurley stage 2 and 3 HS has not been adequate enough to recommend it.9 Treatment of HS requires an aggressive multidisciplinary effort that involves antibiotic treatment, multimodal anti-inflammatory therapy and hormonal therapies, dietary and lifestyle modifications, and avoidance of physical trauma to the affected regions, which can lead to rupture of abscesses, along with early surgical unroofing and debridement. Additionally, because of the stigma and psychological distress, counseling for possible depression and to support coping skills is also recommended.3
A systematic review and meta-analysis of literature on infliximab in hidradenitis suppurativa is conducted.

Infliximab has been found an efficacious treatment in moderate to severe hidradenitis suppurativa (HS), according to findings from a review and meta-analysis published in Dermatologic Therapy.

Investigators sought to provide a review of the efficacy of infliximab in treating HS.

They directed a systematic review and meta-analysis in September, 2021 of 19 articles (6 prospective, 13 retrospective studies) in English with 5 or more HS patients each from MEDLINE and EMBASE databases that included 314 patients in total with HS, of whom 299 had severity data available (moderate to severe). Outcome measures were clinician reported in 16 of the studies, and patient reported or patient plus clinician reported in the remaining 3 studies. Only 5 of these studies were randomized controlled trials (RCTs) or open-label trials.

For patients with HS treated with infliximab the pooled response rate was 83% (95% CI, 0.71-0.91). “Serious adverse events” (AEs) occurred at a rate of 2.9%, a single report each of anaphylactic shock, death from lung malignancy, metastatic squamous cell carcinoma, Hodgkin lymphoma, sepsis, lupus, tuberculosis, and grade 3 multifocal motor neuropathy. Most common AEs were infusion reaction (2.9%) and nonserious infections (13.2%).

Study limitations include heterogeneity between studies and the small number of prospective studies. All but 1 study originated in Europe or North America, possibly limiting generalizability, and reviewers were unable to compare response rates.

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They concluded that infliximab may be an effective treatment for HS, but “Larger RCTs are needed to explore the comparative efficacy of infliximab in HS against other biologics as well as the efficacy of infliximab when combined with other treatment modalities.”

Disclosure: Several study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Shih T, Lee K, Grogan T, De DR, Shi VY, Hsiao JL. Infliximab in hidradenitis suppurativa: a systematic review and meta-analysis. Dermatol Ther. Published online July 5, 2022. doi:10.1111/dth.15691

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