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Molinelli E, Sapigni C, Campanati A, Brisigotti V, Offidani A. Metabolic, pharmacokinetic, and toxicological issues of biologic therapies currently used in the treatment of hidradenitis suppurativa. Expert Opin Drug Metab Toxicol 2020; 16:1019-1037. [PMID: 32896186 DOI: 10.1080/17425255.2020.1810233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Hidradenitis suppurativa is a chronic, relapsing, debilitating inflammatory dermatologic disease of the terminal hair follicles at intertriginous sites clinically characterized by painful inflammatory nodules, abscesses, draining sinus tracts, and dermal fibrosis. The management of hidradenitis suppurativa is a challenge and usually consists of both medical and surgical approaches, which must often be combined for best outcome. The introduction of biological therapies, specifically TNFα-inhibitors such as adalimumab, has profoundly changed the therapeutic armamentarium of the disease. AREAS COVERED The PubMed database was searched using combinations of the following keywords: hidradentis suppurativa, biologic therapy, TNF-α inhibitors, adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, adverse effects, pharmacodynamics, pharmacology, adverse events, pharmacokinetics, drug interaction. This article reviews and updates the chemistry, pharmacokinetics, mechanism of action, adverse effects, drug interactions of on-label and off-label use of TNF-α inhibitors in HS. EXPERT OPINION Biologic agents, particularly adalimumab, exhibit clinical efficacy in patients with hidradenitis suppurativa. Careful patient selection and close monitoring during treatment are mandatory to provide safe and effective use of the TNF-α inhibitor. Familiarity with biologic agents is crucial because these agents could become a consolidated treatment option in the clinician's therapeutic approaches.
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Affiliation(s)
- Elisa Molinelli
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University , Ancona, Italy
| | - Claudia Sapigni
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University , Ancona, Italy
| | - Anna Campanati
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University , Ancona, Italy
| | - Valerio Brisigotti
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University , Ancona, Italy
| | - Annamaria Offidani
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University , Ancona, Italy
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Ocejo-Vinyals JG, Gonzalez-Gay MA, Fernández-Viña MA, Cantos-Mansilla J, Vilanova I, Blanco R, González-López MA. Association of Human Leukocyte Antigens Class II Variants with Susceptibility to Hidradenitis Suppurativa in a Caucasian Spanish Population. J Clin Med 2020; 9:jcm9103095. [PMID: 32992947 PMCID: PMC7600823 DOI: 10.3390/jcm9103095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/17/2020] [Accepted: 09/21/2020] [Indexed: 11/16/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory cutaneous disease of the hair follicle typically presenting recurrent, painful, and inflamed lesions on the inverse areas of the body. Although its pathogenesis remains unknown, the immune system appears to play a potential role. To date, two previous studies have not found any association between the Human Leukocyte Antigen system (HLA) and HS. In this study we analyzed the HLA-A, -B, -C; and DRB1, -DQA1, and –DQB1 allele distribution in 106 HS patients and 262 healthy controls from a Caucasian population in Cantabria (northern Spain). HLA-A*29 and B*50 were significantly more common in HS patients and A*30 and B*37 in controls, but these associations disappeared after statistical correction. DRB1*07, DQA1*02, and DQB1*02 were significantly more common in controls (p 0.026, p 0.0012, and p 0.0005, respectively) and the HLA allele DQB1*03:01 was significantly more common in HS patients (p 0.00007) after the Bonferroni correction. The DRB1*07~DQA1*02~DQB1*02 haplotype was significantly more common in controls (p < 0.0005). This is the first study showing an association between HLA-class II and HS. Our results suggest that HLA-II alleles (DRB1*07, DQA1*02, DQB1*02, and DQB1*03:01) and the DRB1*07~DQA1*02~DQB1*02 haplotype could influence resistance or susceptibility to HS.
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Affiliation(s)
- J. Gonzalo Ocejo-Vinyals
- Department of Immunology, Hospital Universitario Marqués de Valdecilla. Avda. de Valdecilla s/n, 39008 Santander, Cantabria, Spain;
- Correspondence:
| | - Miguel A. Gonzalez-Gay
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, IDIVAL, 39008 Santander, Cantabria, Spain; (M.A.G.-G.); (R.B.)
| | - Marcelo A. Fernández-Viña
- Histocompatibility, Immunogenetics & Disease Profiling Laboratory, Stanford Blood Center, Palo Alto, CA 94304, USA;
| | - Juan Cantos-Mansilla
- Department of Immunology, Hospital Universitario Marqués de Valdecilla. Avda. de Valdecilla s/n, 39008 Santander, Cantabria, Spain;
| | - Iosune Vilanova
- Department of Dermatology, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, IDIVAL, 39008 Santander, Cantabria, Spain; (I.V.); (M.A.G.-L)
| | - Ricardo Blanco
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, IDIVAL, 39008 Santander, Cantabria, Spain; (M.A.G.-G.); (R.B.)
| | - Marcos A. González-López
- Department of Dermatology, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, IDIVAL, 39008 Santander, Cantabria, Spain; (I.V.); (M.A.G.-L)
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Frew JW. Hidradenitis suppurativa is an autoinflammatory keratinization disease: A review of the clinical, histologic, and molecular evidence. JAAD Int 2020; 1:62-72. [PMID: 34409324 PMCID: PMC8361883 DOI: 10.1016/j.jdin.2020.05.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2020] [Indexed: 02/07/2023] Open
Abstract
The pathogenic model of hidradenitis suppurativa is in the midst of a paradigm shift away from a disorder of primary follicular occlusion to an autoinflammatory keratinization disease. Observational, experimental, and therapeutic evidence supports the concept of hidradenitis suppurativa as a primarily inflammatory disorder, a disorder of autoimmunity, or both, in contrast to the current prevailing paradigm of primary follicular occlusion. The lack of reliable and high-fidelity disease models has limited the available experimental and mechanistic evidence to support or refute one pathogenic model over another. This scholarly review synthesizes the existing clinical, histologic, and molecular data to evaluate the extant evidence supporting the autoinflammatory paradigm and further informing the molecular mechanisms of hidradenitis suppurativa pathogenesis. Follicular hyperkeratosis/occlusion and perifollicular inflammation coexist in histologic specimens, with interleukin 1α demonstrated to stimulate comedogenesis in the infundibulum. pH elevation in occluded body sites alters the microbiome and amplifies existing T-helper cell type 17 immunoresponses. Known metabolic comorbidities and smoking are known to upregulate interleukin 1α in follicular keratinocytes. Identified genetic variants may alter epidermal growth factor receptor signaling, leading to upregulated keratinocyte inflammatory responses. The process of follicular rupture and dermal tunnel formation can be explained as secondary responses to inflammatory activation of fibroblasts and epithelial-mesenchymal transition, with antibody production associated with inflammatory amplification in advanced disease. This review aims to reevaluate and integrate the current clinical, histologic, and molecular data into a pathogenic model of hidradenitis suppurativa. This is essential to advance our understanding of the disease and identify novel therapeutic targets and approaches.
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Affiliation(s)
- John W Frew
- Laboratory of Investigative Dermatology, Rockefeller University, New York, New York
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Montero-Vilchez T, Bueno-Rodriguez A, Salvador-Rodriguez L, Arias-Santiago S, Molina-Leyva A. Could vascular endothelial growth factor inhibitors induce hidradenitis suppurativa? Report of three patients with renal cancer treated with sunitinib. Dermatol Ther 2020; 33:e13306. [PMID: 32181974 DOI: 10.1111/dth.13306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 03/09/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Trinidad Montero-Vilchez
- Dermatology Department, Hidradenitis Suppurativa Clinic, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Ahinoa Bueno-Rodriguez
- Dermatology Department, Hidradenitis Suppurativa Clinic, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Luis Salvador-Rodriguez
- Dermatology Department, Hidradenitis Suppurativa Clinic, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Salvador Arias-Santiago
- Dermatology Department, Hidradenitis Suppurativa Clinic, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain
| | - Alejandro Molina-Leyva
- Dermatology Department, Hidradenitis Suppurativa Clinic, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain.,Dermatology Department, University of Granada, Granada, Spain.,European Hidradenitis Suppurativa Foundation (EHSF), Dessau-Roßlau, Germany
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Leflunomide-Induced Hidradenitis Suppurativa. Case Rep Rheumatol 2020; 2020:3549491. [PMID: 32148994 PMCID: PMC7049404 DOI: 10.1155/2020/3549491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 12/02/2019] [Indexed: 11/24/2022] Open
Abstract
Hidradenitis suppurativa is an inflammatory disease of the pilosebaceous unit with a chronic intermittent course and a devastating effect on quality of life. Rare reports of drug-induced hidradenitis suppurativa exist. We report on 2 women on follow-up for rheumatoid arthritis, who presented hidradenitis suppurativa after different periods of treatment with leflunomide and who improved few weeks after discontinuation of the medication.
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Salvador-Rodriguez L, Montero-Vílchez T, Arias-Santiago S, Molina-Leyva A. Paradoxical Hidradenitis Suppurativa in Patients Receiving TNF-α Inhibitors: Case Series, Systematic Review, and Case Meta-Analysis. Dermatology 2020; 236:307-313. [PMID: 32135533 DOI: 10.1159/000506074] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 01/17/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND/AIMS TNF-α inhibitors represent the most advanced approved therapeutic option for moderate and severe forms of hidradenitis suppurativa (HS). However, in recent years, cases of paradoxical HS secondary to the use of these biological drugs have been described, with very few cases reported in the literature. The aims of this study are (1) to present 2 new cases of paradoxical HS and (2) to perform a systematic review of scientific evidence regarding paradoxical HS with TNF-α inhibitors. MATERIAL AND METHODS This is a retrospective study in which we searched all the cases of paradoxical HS secondary to the use of TNF-α inhibitors published in the literature and included two additional cases observed in our clinical practice. RESULTS A total of 34 patients under TNF-α inhibitor treatment were included (adalimumab = 21; infliximab = 9; etanercept = 4). The median delay from exposure to TNF-α inhibitor and the development of paradoxical HS was 12 months (range 1-72). The majority of patients were Hurley stage II (58.8%). Clinical improvement and complete remission were more frequent when the TNF-α inhibitor was stopped or switched to another biological agent with a different therapeutic target rather than maintenance or change to another TNF-α inhibitor. CONCLUSIONS Paradoxical HS is an unusual adverse effect of TNF-α inhibitors. When this adverse effect appears, interruption or substitution of treatment is associated with a better clinical outcome.
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Affiliation(s)
- Luis Salvador-Rodriguez
- Hidradenitis Suppurativa Clinic, Dermatology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Instituto de Investigación Biosanitaria, Ibs Granada, Granada, Spain
| | - Trinidad Montero-Vílchez
- Hidradenitis Suppurativa Clinic, Dermatology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Instituto de Investigación Biosanitaria, Ibs Granada, Granada, Spain
| | - Salvador Arias-Santiago
- Hidradenitis Suppurativa Clinic, Dermatology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain, .,Instituto de Investigación Biosanitaria, Ibs Granada, Granada, Spain,
| | - Alejandro Molina-Leyva
- Hidradenitis Suppurativa Clinic, Dermatology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain.,European Hidradenitis Suppurativa Foundation (EHSF), Dessau-Rosslau, Germany.,Instituto de Investigación Biosanitaria, Ibs Granada, Granada, Spain
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Shavit E, Alavi A, Bechara FG, Bennett RG, Bourcier M, Cibotti R, Daveluy S, Frew JW, Garg A, Hamzavi I, Hoffman LK, Hsaio J, Sciacca Kirby J, Lev-Tov H, Martinez E, Micheletti R, Naik HB, Nassif A, Nicholson C, Parks-Miller A, Patel Z, Piguet V, Ramesh M, Resnik B, Sayed C, Schultz G, Siddiqui A, Tan J, Wortsman X, Lowes MA. Proceeding report of the Second Symposium on Hidradenitis Suppurativa Advances (SHSA) 2017. Exp Dermatol 2019; 28:94-103. [PMID: 30484907 PMCID: PMC6600821 DOI: 10.1111/exd.13849] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 11/13/2018] [Accepted: 11/20/2018] [Indexed: 12/27/2022]
Abstract
The 2nd Annual Symposium on Hidradenitis Suppurativa Advances (SHSA) took place on 03-05 November 2017 in Detroit, Michigan, USA. This symposium was a joint meeting of the Hidradenitis Suppurativa Foundation (HSF Inc.) founded in the USA, and the Canadian Hidradenitis Suppurativa Foundation (CHSF). This was the second annual meeting of the SHSA with experts from different disciplines arriving from North America, Europe and Australia, in a joint aim to discuss most recent innovations, practical challenges and potential solutions to issues related in the management and care of Hidradenitis Suppurativa patients. The last session involved clinicians, patients and their families in an effort to educate them more about the disease.
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Affiliation(s)
- Eran Shavit
- Department of Medicine, Division of Dermatology, Women College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Afsaneh Alavi
- Department of Medicine, Division of Dermatology, Women College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Falk G. Bechara
- Department of Dermatology, Dermatologic Surgery Unit, Ruhr-University Bochum, Bochum, Germany
| | - Richard G. Bennett
- Department of Dermatology, University of California, Los Angeles, Los Angeles, California
| | - Marc Bourcier
- Dermatology Clinic, Sherbrooke University, Moncton, New Brunswick, Canada
| | - Ricardo Cibotti
- National Institute of Arthritis and Musculoskeletal and skin diseases, National Institute of Health, Bethesda, Maryland
| | - Steven Daveluy
- Department of Dermatology, Wayne State University, Dearborn, Michigan
| | - John W. Frew
- Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Amit Garg
- Department of Dermatology, Hofstra Northwell School of Medicine, New Hyde Park, New York
| | - Iltefat Hamzavi
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Lauren K. Hoffman
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Jenny Hsaio
- Ronald Reagan UCLA Medical Center, Santa Monica, California
| | | | - Hadar Lev-Tov
- Department of Dermatology & Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | | | - Robert Micheletti
- Departments of Dermatology and Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Haley B. Naik
- Department of Dermatology, UCSF School of Medicine, San Francisco, California
| | - Aude Nassif
- Institut Pasteur, Centre Medical, Paris, France
| | - Cynthia Nicholson
- Department of Dermatology, Wayne State University, Detroit, Michigan
| | - Angie Parks-Miller
- Department of Dermatology, Dermatologic Surgery Unit, Ruhr-University Bochum, Bochum, Germany
- Clinical Research Manager, Henry Ford Hospital, Detroit, Michigan
| | - Zarine Patel
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York
| | - Vincent Piguet
- Department of Medicine, Division of Dermatology, Women College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Mayur Ramesh
- Department of Internal Medicine/Infectious Diseases, Henry Ford Hospital, Detroit, Michigan
| | - Barry Resnik
- Department of Dermatology & Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Christopher Sayed
- Department of Dermatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Gregory Schultz
- Institute of Wound Research, University of Florida, Gainesville, Florida
| | - Aamir Siddiqui
- Department of Plastic Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Jerry Tan
- Department of Medicine, University of Western Ontario, Windsor, Ontario, Canada
| | - Ximena Wortsman
- Department of Dermatology, Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, University of Chile, Santiago, Chile
- Department of Dermatology, Pontifical Catholic University, Santiago, Chile
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8
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Gkini MA, Bewley AP. Development of hidradenitis suppurativa in a patient treated with ustekinumab for her psoriasis: A potential paradoxical reaction? Dermatol Ther 2018; 31:e12742. [PMID: 30221819 DOI: 10.1111/dth.12742] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 08/24/2018] [Accepted: 09/09/2018] [Indexed: 01/02/2023]
Affiliation(s)
- M-A Gkini
- Dermatology Department, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - A P Bewley
- Dermatology Department, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
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