1
|
Kim Y, Lee J, Kim HS, Ko HC, Kim BS, Kim MB, Shin K. Review of Scoring Systems for Hidradenitis Suppurativa. Ann Dermatol 2024; 36:9-17. [PMID: 38325429 PMCID: PMC10861310 DOI: 10.5021/ad.23.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/05/2023] [Accepted: 11/06/2023] [Indexed: 02/09/2024] Open
Abstract
Hidradenitis suppurativa (HS) is an inflammatory disorder characterized by chronic deep-seated nodules, abscesses, fistulae, sinus tracts, and scars in apocrine gland-bearing regions. Assessing its severity is challenging because of its clinical heterogeneity, lack of a standardized tool, and increasing severity scores. This article provides a chronological overview of HS grading scales to aid in the understanding and comparison of different scoring systems. A literature review of articles published in English on PubMed was conducted searched from 1989 to 2023. The review includes 15 scores that are the most relevant and widely used and acknowledges the existence of over 30 scoring systems for HS. The expanding landscape of HS scoring systems presents challenges when patients evaluated using different systems are compared. A universally accepted scoring system is required for consistent application across diverse populations. A comprehensive assessment should balance subjective and objective items, considering observer-reported signs and patient-reported symptoms to make meaningful treatment decisions.
Collapse
Affiliation(s)
- Youngbeom Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jungsoo Lee
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
- Department of Dermatology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hoon-Soo Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hyun-Chang Ko
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
- Department of Dermatology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Byung-Soo Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Moon-Bum Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Kihyuk Shin
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
- Department of Dermatology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
| |
Collapse
|
2
|
Koerts NDK, Bouwman K, Prens LM, Horváth B. Assessment tools and phenotype classification for hidradenitis suppurativa. Clin Dermatol 2023; 41:601-610. [PMID: 37652190 DOI: 10.1016/j.clindermatol.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Hidradenitis suppurativa (HS) is a heterogeneous chronic relapsing skin disease. Several assessment tools are used to assess disease severity and to classify disease phenotype; however, no consensus exists. This review evaluates the various assessment tools and phenotypes, assessing their validity and reliability. Numerous assessment tools and phenotype classifications have been proposed for identifying various subtypes within the hidradenitis suppurativa disease spectrum. Each has a different purpose, such as use in daily practice or in clinical trial settings. Several assessment tools and phenotype classifications have been validated but not always with satisfactory results and often with studies showing divergent intra-rater reliability results. A consensus is needed for a validated, easy-to-use, and timesaving assessment tool for routine daily practice. For clinical trials, a validated and extensive assessment tool that also measures response to treatment is also needed.
Collapse
Affiliation(s)
- Nicole D K Koerts
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Klasiena Bouwman
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lisette M Prens
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Barbara Horváth
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
3
|
Bellefeuille G, Paiewonsky B, Khalid B, Freese RL, Lowes M, Kirby JS, Alavi A, Goldfarb N. Worst area local Hidradenitis suppurativa Activity and Severity Index-Revised (W-HASI-R): a study evaluating construct validity. Br J Dermatol 2023; 189:338-354. [PMID: 37143371 PMCID: PMC10449531 DOI: 10.1093/bjd/ljad138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 04/13/2023] [Accepted: 05/20/2023] [Indexed: 05/06/2023]
Abstract
Current validated hidradenitis suppurativa (HS) severity assessment tools are time-consuming and impractical in fast-paced, ambulatory clinic settings. This study evaluated the construct validity of the most severe or ‘worst’ area local Hidradenitis suppurativa Activity and Severity Index-Revised (W-HASI-R) as a novel target area assessment tool for clinical setting use. W-HASI-R had strong association with the International Hidradenitis Suppurativa Severity Score System and abscess and nodule count, moderate association with Hurley stage and HS physician global assessment and weak, negative association with reverse-scored Dermatology Quality Life Index. The resulting data suggest that W-HASI-R may be an option as an efficient target area assessment tool for fast-paced, ambulatory settings.
Collapse
Affiliation(s)
| | - Briana Paiewonsky
- Departments of Dermatology and
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | | | - Rebecca L Freese
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA
| | | | - Joslyn S Kirby
- Department of Dermatology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Noah Goldfarb
- Departments of Dermatology and
- Medicine, University of Minnesota Academic Health Center, Minneapolis, MN, USA
- Departments of Medicine and Dermatology, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
| |
Collapse
|
4
|
Xia E, Li SJ, Drake L, Reyes-Hadsall S, Mita C, Drucker AM, Mostaghimi A. An Assessment of Current Clinician-Reported and Patient-Reported Outcome Measures for Alopecia Areata: A Scoping Review. J Invest Dermatol 2023; 143:1133-1137.e12. [PMID: 37115113 DOI: 10.1016/j.jid.2023.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 02/04/2023] [Accepted: 02/13/2023] [Indexed: 04/29/2023]
Abstract
Although progress has been made in developing outcome measures for AA, the use of these measures remains unstandardized. A scoping review was conducted to identify the clinician-reported outcome measures (ClinROMs) and patient-reported outcome measures (PROMs) used in assessing and treating AA, the results of which revealed heterogeneity in AA outcome measures. Of 23 research studies ultimately included, only 2 ClinROMs were used by >15% of studies; likewise, of 110 clinical trials evaluated, numerous outcome instruments were used, but only one ClinROM was used by >5% of trials (Severity of Alopecia Tool). These results suggest the need for consensus and standardization in both research and trial settings.
Collapse
Affiliation(s)
- Eric Xia
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Chobanian & Avedisian School of Medicine, Boston University, Boston, Massachusetts, USA
| | - Sara J Li
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Lara Drake
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Sophia Reyes-Hadsall
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Carol Mita
- Countway Library, Harvard Medical School, Boston, Massachusetts, USA
| | - Aaron M Drucker
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| |
Collapse
|
5
|
Bellefeuille G, Paiewonsky B, Khalid B, Freese RL, Lowes MA, Kirby JS, Alavi A, Goldfarb N. Inflammatory induration in hidradenitis suppurativa and application to severity assessment. Br J Dermatol 2023; 188:309-310. [PMID: 36634097 DOI: 10.1093/bjd/ljac076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/06/2022] [Accepted: 10/24/2022] [Indexed: 01/13/2023]
Abstract
Skin thickness, as known as inflammatory induration, is a component in several HS grading instruments including the HASI and HASI-R. This study sought to evaluate how thickest lesion measurement (mm) corresponds to HS severity. This study demonstrates that inflammatory induration has moderate association with HS severity, thickest lesion measurement (mm) demonstrates known-validity across Hurley stages, and cut-offs for thickest lesion measurement (mm) were determined for inflammatory induration grading for the purpose of HASI-R training.
Collapse
Affiliation(s)
| | - Briana Paiewonsky
- Department of Dermatology.,Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL, USA
| | | | - Rebecca L Freese
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA
| | | | - Joslyn S Kirby
- Department of Dermatology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Noah Goldfarb
- Department of Dermatology.,Department of Dermatology, Mayo Clinic, Rochester, MN, USA.,Departments of Medicine and Dermatology, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA.,Department of Medicine, University of Minnesota Academic Health Center, Minneapolis, MN, USA
| |
Collapse
|
6
|
Daoud M, Suppa M, Benhadou F, Daxhelet M, Njimi H, White J, Jemec G, del Marmol V. Overview and comparison of the clinical scores in hidradenitis suppurativa: A real-life clinical data. Front Med (Lausanne) 2023; 10:1145152. [PMID: 37138732 PMCID: PMC10149852 DOI: 10.3389/fmed.2023.1145152] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/13/2023] [Indexed: 05/05/2023] Open
Abstract
Introduction Partly due to its clinical heterogeneity, hidradenitis suppurativa (HS) is difficult to score accurately; illustrated by the large number of disease scores. In 2016, a systematic review by Ingram et al. reported the use of about thirty scores, and since then, this number has increased further. Our aim is twofold: to provide a succinct but detailed narrative review of the scores used to date, and to compare these scores with each other for individual patients. Materials and methods The review of the literature was done among articles in English and French, on Google, Google scholar, Pubmed, ScienceDirect and Cochrane. To illustrate the differences between scores, data from some Belgian patients included in the European Registry for HS were selected. A first series of patients compares the severity of the following scores: Hurley, Hurley Staging refined, three versions of Sartorius score (2003, 2007, 2009), Hidradenitis Suppurativa Physician Global Assessment (HS-PGA), International Hidradenitis Suppurativa Severity Scoring System (IHS4), Severity Assessment of Hidradenitis Suppurativa (SAHS), Hidradenitis Suppurativa Severity Index (HSSI), Acne Inversa Severity Index (AISI), the Static Metascore, and one score that is not specific to HS: Dermatology Life Quality Index (DLQI). A second set of patients illustrates how some scores change over time and with treatment: Hurley, Hurley Staging refined, Sartorius 2003, Sartorius 2007, HS-PGA, IHS4, SAHS, AISI, Hidradenitis Suppurativa Clinical Response (HiSCR), the very new iHS4-55, the Dynamic Metascore, and DLQI. Results Nineteen scores are detailed in this overview. We illustrate that for some patients, the scores do not predictably and consistently correlate with each other, either in an evaluation of the severity at a time-point t, or in the evaluation of the response to a treatment. Some patients in this cohort may be considered responders according to some scores, but non-responders according to others. The clinical heterogeneity of the disease, represented by its many phenotypes, seems partly to explain this difference. Conclusion These examples illustrate how the choice of a score can lead to different interpretations of the response to a treatment, or even potentially change the results of a randomized clinical trial.
Collapse
Affiliation(s)
- Mathieu Daoud
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
- *Correspondence: Mathieu Daoud,
| | - Mariano Suppa
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Farida Benhadou
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Mathilde Daxhelet
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Hassane Njimi
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Jonathan White
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Gregor Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
- Health Sciences Faculty, University of Copenhagen, København, Denmark
| | - Véronique del Marmol
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| |
Collapse
|
7
|
van Straalen KR, Ingram JR, Augustin M, Zouboulis CC. New treatments and new assessment instruments for hidradenitis suppurativa. Exp Dermatol 2022; 31 Suppl 1:33-39. [PMID: 35582833 PMCID: PMC9542859 DOI: 10.1111/exd.14609] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/08/2022] [Accepted: 05/15/2022] [Indexed: 11/26/2022]
Abstract
Research interest in Hidradenitis Suppurativa (HS) has grown exponentially over the past decades. Several groups have worked to develop novel scores that address the drawbacks of existing investigator assessed and patient reported outcome measures currently used in HS trials, clinical practice and research. In clinical trial settings, the drawbacks of the HiSCR have become apparent; mainly it's lack of a dynamic measurement of draining tunnels. The newly developed (dichotomous) IHS4 and HASI-R are backed up by adequate validation data and are good contenders to become the new primary outcome measure in HS clinical trials. Patient reported outcomes, as well as physician reported measures, are being developed by the HIdradenitis SuppuraTiva cORe outcomes set International Collaboration (HISTORIC). For example, the Hidradenitis Suppurativa Quality of Life (HiSQOL) score is a validated measure of HS-specific quality of life and is already being used in many HS trials. Magnitude of pain measurement via a 0-10 numerical rating scale is well-established, however consensus is still required to ensure consistent administration and interpretation of the instrument. A longitudinal measurement over multiple days rather than at one time point, such as for example the Pain Index could provide increased reliability and reduced recall bias. Ultimately, these newly developed scores and tools can be included in a standardized registry to be used in routine clinical practice.
Collapse
Affiliation(s)
- K R van Straalen
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA.,European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - J R Ingram
- Department of Dermatology, Division of Infection & Immunity, Cardiff University, Cardiff, UK.,European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - M Augustin
- Institute for Health Care Services Research in Dermatology and Nursing, University Hospital Medical Center Hamburg-Eppendorf, Hamburg, Germany.,European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - C C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany.,European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| |
Collapse
|
8
|
Frew JW, Jiang CS, Singh N, Navrazhina K, Vaughan R, Krueger JG. Quantifying the natural variation in lesion counts over time in untreated hidradenitis suppurativa: Implications for outcome measures and trial design. JAAD Int 2021; 1:208-221. [PMID: 34409342 PMCID: PMC8361889 DOI: 10.1016/j.jdin.2020.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2020] [Indexed: 11/05/2022] Open
Abstract
Background Hidradenitis suppurativa (HS) demonstrates high placebo response rates in clinical trials, possibly due to the natural variability of the disease. No quantification of variability in lesion counts of untreated disease has been undertaken. Objective To quantify the variability of untreated HS. Methods Deidentified individual patient data from the placebo arms of PIONEER studies were analyzed, and measurements of within-subject coefficients of variation were examined. Variability was stratified by disease-associated variables (Hurley stage, BMI, sex, smoking, family history) and body site. Results Analysis of within-subject coefficients of variation demonstrated that half of the participants had a middle spread [difference between 75th and 25th percentiles of the subject's abscess and nodule counts] greater than 33% and 40% of their median abscess and nodule counts, and 25% of the subjects had a middle spread greater than 70% and 78% of their median abscess and nodule counts in PIONEER I and II, respectively. Hurley stage 2 participants had significantly greater within-subject variation than Hurley stage 3 patients. Variation was greater in the axillary and groin regions than in other anatomical locations. Limitations Limitations include the use of precollected clinical trial data. Conclusion The within-subject variability of the lesion counts in untreated HS was greater than previously appreciated. This has profound effects on outcome measures and the conduct of future clinical trials of HS.
Collapse
Affiliation(s)
- John W Frew
- Laboratory of Investigative Dermatology, Rockefeller University, New York, New York
| | - Caroline S Jiang
- Department of Biostatistics, Rockefeller University, New York, New York
| | - Neha Singh
- Department of Biostatistics, Rockefeller University, New York, New York
| | - Kristina Navrazhina
- Weill Cornell/Rockefeller/Sloan Kettering Tri-Institutional MD-PhD Program, Weill Cornell, New York, New York
| | - Roger Vaughan
- Department of Biostatistics, Rockefeller University, New York, New York
| | - James G Krueger
- Laboratory of Investigative Dermatology, Rockefeller University, New York, New York
| |
Collapse
|
9
|
Shaver RL, Jemec GBE, Freese R, Alavi A, Lowes MA, Goldfarb N. A survey of clinicians regarding preferred severity assessment tools for hidradenitis suppurativa. Int J Dermatol 2020; 60:e248-e251. [PMID: 33179770 DOI: 10.1111/ijd.15295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/09/2020] [Accepted: 10/13/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Rob L Shaver
- School of Medicine, University of Minnesota-Twin Cities, Minneapolis, MN, USA
| | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Department of Dermatology, University of Copenhagen, Copenhagen, Denmark
| | - Rebecca Freese
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA
| | - Afsaneh Alavi
- Division of Dermatology, Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada.,Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Noah Goldfarb
- Departments of Medicine and Dermatology, University of Minnesota, Minneapolis, MN, USA.,Departments of Medicine and Dermatology, Minneapolis Veteran Affairs Health Care System, Minneapolis, MN, USA
| |
Collapse
|
10
|
Goldfarb N, Lowes MA, Butt M, King T, Alavi A, Kirby JS. Hidradenitis Suppurativa Area and Severity Index Revised (HASI-R): psychometric property assessment. Br J Dermatol 2020; 184:905-912. [PMID: 32969027 DOI: 10.1111/bjd.19565] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 08/09/2020] [Accepted: 09/21/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Validated, reliable, globally accepted outcome measurement instruments for hidradenitis suppurativa (HS) are needed. Current tools to measure the physical signs domain for HS rely on lesion counts, which are time-consuming and unreliable. OBJECTIVES To assess the reliability and validity of the Hidradenitis suppurativa Area and Severity Index Revised (HASI-R) tool, a novel method for assessing HS severity, incorporating signs of inflammation and body surface area involved. METHODS The measurement properties of the HASI-R tool were evaluated. The tool was created by combining the previously published HASI and Severity and Area Score for Hidradenitis instruments. Twenty raters evaluated 15 patients with HS in a hospital-based ambulatory dermatology clinic. The objectives of the study were to assess inter- and intra-rater reliability of the HASI-R and its components, as well as its construct and known-groups validity. Existing lesion count-based clinician-reported measures of HS and their components were also assessed. Raters were also asked their preferences regarding the various HS severity assessment tools. RESULTS The HASI-R had moderate inter-rater reliability [intra-class correlation coefficients (ICC) 0·60]. This was better than all other HS physical sign outcome measures evaluated, which had poor inter-rater reliability (ICC < 0·5). HASI-R had the highest intra-rater reliability (ICC 0·91). The HASI-R had good construct validity and demonstrated known-groups validity. The HASI-R was also the most preferred tool by all raters. CONCLUSIONS Results from the clinometric assessment of the HASI-R are encouraging, and support continued evaluation of this clinician-reported outcome measure.
Collapse
Affiliation(s)
- N Goldfarb
- Departments of Medicine and Dermatology, University of Minnesota, Minneapolis, MN, USA.,Departments of Medicine and Dermatology, Minneapolis Veteran Affairs Health Care System, Minneapolis, MN, USA
| | - M A Lowes
- The Rockefeller University, New York, NY, USA
| | - M Butt
- Department of Dermatology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - T King
- Department of Dermatology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - A Alavi
- Department of Medicine, Division of Dermatology, Women's College Hospital, University of Toronto, Toronto, Canada
| | - J S Kirby
- Department of Dermatology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| |
Collapse
|
11
|
Wortsman X. Strong validation of ultrasound as an imaging biomarker in hidradenitis suppurativa. Br J Dermatol 2020; 184:591-592. [PMID: 32869312 DOI: 10.1111/bjd.19433] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 07/21/2020] [Indexed: 01/01/2023]
Affiliation(s)
- X Wortsman
- Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Santiago, Chile.,Department of Dermatology, Faculty of Medicine, Universidad de Chile, Santiago, Chile.,Department of Dermatology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| |
Collapse
|
12
|
Wortsman X. Color Doppler ultrasound: a standard of care in hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2020; 34:e616-e617. [PMID: 32314414 DOI: 10.1111/jdv.16496] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 04/03/2020] [Indexed: 01/21/2023]
Affiliation(s)
- X Wortsman
- Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Santiago, Chile.,Department of Dermatology, School of Medicine, Universidad de Chile, Santiago, Chile.,Department of Dermatology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| |
Collapse
|
13
|
Frew JW, Jiang CS, Singh N, Grand D, Navrazhina K, Vaughan R, Krueger JG. Clinical response rates, placebo response rates, and significantly associated covariates are dependent on choice of outcome measure in hidradenitis suppurativa: A post hoc analysis of PIONEER 1 and 2 individual patient data. J Am Acad Dermatol 2019; 82:1150-1157. [PMID: 31881294 DOI: 10.1016/j.jaad.2019.12.044] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/12/2019] [Accepted: 12/17/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The hidradenitis suppurativa clinical response (HiSCR) is the gold standard primary outcome measure for hidradenitis suppurativa clinical trials; however, it does not assess the presence of draining tunnels, a common finding in advanced disease. It is unclear what the effect of the presence or absence of draining tunnels has on the efficacy of adalimumab therapy in moderate and advanced disease. OBJECTIVES We evaluated the efficacy of adalimumab versus placebo using the International Hidradenitis Suppurativa Severity Scoring System (IHS4). Additionally, we assessed the effect of draining tunnels on therapeutic response as measured by both the HiSCR and change in nodule counts. METHODS Reanalysis was conducted with the IHS4 and PIONEER 1 and 2 individual patient data. Both binary outcomes (achieving HiSCR and achieving change in IHS4 severity category) and continuous outcomes (nodule counts and IHS4 score) were calculated with R. Regression modeling was undertaken to assess the effect of draining tunnels and other variables. P < .05 was considered statistically significant. RESULTS The significance of adalimumab therapy depended on the outcome measure used. Placebo response rates were highest when binary outcome measures were used. Draining tunnels, smoking, antibiotics, and body mass index influenced HiSCR response in PIONEER 2. Significant differences in disease severity were observed between PIONEER 1 and 2 data sets. CONCLUSIONS Elevated placebo response rates in PIONEER 1 and 2 are partially attributable to the use of binary outcome measures. Draining tunnels influence clinical response as measured by HiSCR and nodule counts in PIONEER 2. Further investigation into the effect of body mass index on clinical response is required.
Collapse
Affiliation(s)
- John W Frew
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, New York.
| | - Caroline S Jiang
- Department of Biostatistics, The Rockefeller University, New York, New York
| | - Neha Singh
- Department of Biostatistics, The Rockefeller University, New York, New York
| | - David Grand
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, New York; Albert Einstein College of Medicine, Bronx, New York
| | - Kristina Navrazhina
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, New York; Weill Cornell/Rockefeller/Sloan Kettering Tri-Institutional MD-PhD Program, Weill Cornell University, New York, New York
| | - Roger Vaughan
- Department of Biostatistics, The Rockefeller University, New York, New York
| | - James G Krueger
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, New York
| |
Collapse
|
14
|
Frew JW. Putting nodule counts behind us: hidradenitis suppurativa outcome measures independent of descriptive semantics. Br J Dermatol 2019; 182:829-830. [PMID: 31486069 DOI: 10.1111/bjd.18436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- J W Frew
- Laboratory of Investigative Dermatology, Rockefeller University, 1230 York Avenue, New York, NY, 10065, U.S.A
| |
Collapse
|