International experts have worked on a revised series of recommendations for the treatment and management of hidradenitis suppurativa (HS), and they have published their findings in the Journal of the European Academy of Dermatology and Venereology.
The aim of this group of researchers was to perform a systematic review of the existing guidelines for treatment for HS and provide practical suggestions for the use of tools and treatment.
The review included 5310 articles, with researchers analyzing 171 articles and deriving recommendations from 65. A number of clinical questions were identified for developing consensus recommendations. Topical treatment with clindamycin in mild disease and treatment with adalimumab and other biological agents after failure of conventional therapies emerged as having the highest evidence in regard to dosing recommendations.
Validated measures of outcome were examined, and reviewers found that hidradenitis suppurativa clinical response has good quality evidence to support its use in HS treatment. Findings also included frequent resistance to clindamycin despite it being a first option for treatment. Systemic treatment with tetracyclines is considered an alternative, but they are not available in many countries. Ertapenem has also been recommended for use in treatment of severe cases at the discretion of the treating clinician.
The amount of high-level evidence available for treatment with adalimumab has led to its use as a first-line biologic agent for HS therapy. The indicated dose of adalimumab for HS is 160 mg on day 1, 80 mg on day 15, and a single 40 mg injection every week from week 4 onward. The review also found that infliximab use is supported by high-quality evidence. The dosing schedule for infliximab is 5 mg/kg body weight on days 0, 2, and 6 and then every 8 weeks. The review found no evidence for infection as a causal factor for HS.
Investigators recommend further research that might provide more data and higher quality evidence for HS treatment. Future studies could further examine validated outcome measures, patient-reported outcomes, and long-term data. The scarcity of data available on optimal treatment strategies and long-term outcomes limit this review, as do differences in the ways investigators perform their reviews. Nonetheless, researchers conclude that this review done on available data is valuable in providing a comprehensive and transparent set of current, consensus guidelines for treating HS.
Funding for this study has been provided by AbbVie. Multiple authors declare associations with the pharmaceutical industry. Please refer to original reference for a full list of authors’ disclosures.
Zouboulis CC, Bechara FG, Dickinson-Blok JL, et al. Hidradenitis suppurativa/acne inversa: A practical framework for treatment optimization – systematic review and recommendations from the HS ALLIANCE working group [Published online September 3, 2018]. J Eur Acad Dermatol. doi: 10.1111/jdv.15233