Adalimumab Treats Hidradenitis Suppurativa But Has Multisystem Adverse Event Profile

Adalimumab effectively improves symptoms of hidradenitis suppurativa (HS) and quality of life in HS patients, yet causes a wide variety of adverse events that are most concerning in mental health, according to data from an analysis published in Dermatologic Therapy.

Investigators conducted a retrospective cross-sectional study to evaluate adalimumab’s effect on physical symptoms and quality of life in adult patients with moderate to severe HS who failed conventional HS treatment and were on adalimumab therapy (40 mg weekly) for at least 6 months. The HS physician global assessment (HS-PGA) was employed to assess physical symptoms and the disease life quality index (DLQI) score to assess quality of life.

Their secondary objective was to record any patient-reported adverse effects, as well as psychological, social, and occupational effects.

There were 101 patients included in the final analysis, and 23 were excluded from the HS-PGA score analysis due to inadequate reporting. Of the remaining 78 patients (77%), 62 had improved HS-PGA scores, with 24 of 62 reporting improvement in discharge, 18 of 62 reporting improved nodules, 16 of 62 reporting improved pain, and 6 of 62 reporting complete remission.

Investigators found a significant improvement in the DLQI scores recorded in patients before (n=48) and after (n=45) adalimumab treatment initiation in both paired (n=26) and unpaired data groups (P =.0001).

Of the original 101 patients started on adalimumab, 3 reported improvements in body image and ability to wear their preferred clothing, 2 reported improved joint mobility, and 3 reported improved occupational function.

There were 32 (31.7%) patients who reported adverse effects. Of note, 3 patients with a history of mental health disorders reported psychological side effects including depression, obsessive compulsive disorder (OCD) symptoms, increased preexisting anorexia nervosa symptoms, and worsening of preexisting suicidal ideation. A total of 28 (27.7%) patients stopped treatment, most (n=20) citing adverse events that spanned multiple organ systems as their reason.

Study limitations included limited data on smoking and BMI, 2 known confounding factors for HS.

“Based on our study findings, we strongly advocate for regular systemic and holistic assessment for patients with HS on long-term biologic treatment,” the study authors wrote.

Reference

Muralidharan V, Pathmarajah P, Peterknecht E, et al. Real life data on the biopsychosocial effects of adalimumab in the management of hidradenitis suppurative: A multicenter cross-sectional analysis and consideration of a multisystem monitoring approach to follow up. Dermatol Ther. Published online January 5, 2021. doi:10.1111/dth.14643