Flares as dynamic predictive factor of response to adalimumab in hidradenitis suppurativa, real-life data

Factors associated with therapeutic response to adalimumab in hidradenitis suppurativa: evidence from the Belgian patients of the European Registry for Hidradenitis Suppurativa (ERHS-Be)

Hidradenitis suppurativa is an inflammatory skin disease for which adalimumab is an effective treatment in just over half of cases. Few factors associated with therapeutic response, and therefore potentially predictive of response, are known to date. This real-life study retrospectively explores the existence of such factors in a Belgian cohort of 82 patients, using several response scores: the Hidradenitis Suppurativa Clinical Response (HiSCR), the International Hidradenitis Suppurativa Severity Scoring System-55 (iHS4-55), and the dynamic metascore (a combination of the Hurley score, the 2007 version of the Sartorius score, the iHS4 and the HiSCR). Among the factors associated with a good therapeutic response, we find, for example, the "Frictional furunculoid" and "Conglobata" phenotypes, in contrast to the "Scarring folliculitis" phenotype, which is associated with a poorer response to treatment. Other factors associated with a good response to treatment were observed, such as the patient's description of longer flares, or, among others, the presence of inflammatory bowel disease. Subject to our sample size, the window of opportunity for adalimumab, whereby the treatment would be more effective if administered earlier, was not found in this study.

Biologics for Hidradenitis suppurativa: evolution of the treatment paradigm

INTRODUCTION

Hidradenitis suppurativa (HS) is an autoinflammatory skin disease with a high unmet need for effective medical management. Clinically, it is characterized by inflammatory nodules that may progress into abscesses, draining tunnels and extensive scarring, mainly affecting apocrine gland-bearing areas.

AREAS COVERED

Treatment options include topical and systemic medications and a variety of surgical procedures. The anti-TNF-α antibody adalimumab and the anti-IL-17 secukinumab are the only two approved biologics for HS, showing moderate efficacy. HS research is a rapidly growing field, with a wide range of agents leveraging distinct mechanisms of action currently under development. Drugs targeting the IL-17 and Janus kinase/signal transducer and activator of transcription (JAK/STAT) pathways are the most advanced in both ongoing and completed Phase 3 studies, promising deeper levels of response. Use of other, off-label biologics is also discussed.

EXPERT OPINION

A therapeutic algorithm is proposed based on comorbidities and existing evidence. Patient-tailored combinations between biologics and other biologics or small molecules will hopefully allow clinicians to target most events in HS pathophysiology in a complementary way while obtaining a meaningful effect on their devastating manifestations.

Adalimumab, Ustekinumab, and Secukinumab in the Management of Hidradenitis Suppurativa: A Review of the Real-Life Experience

To date, adalimumab (ADA) is the only biotechnology drug approved for the management of hidradenitis suppurativa (HS), an inflammatory skin condition. However, it quickly became apparent that the efficacy of adalimumab in daily practice was highly variable. In our review, we highlighted the current evidence from literature on the use of biologics in HS in a real-life setting, particularly adalimumab, secukinumab and ustekinumab. Data on the effectiveness and safety of biologic drugs in HS management have been analyzed. Even if the results are promising, more studies are needed. In our opinion, the armamentarium of drugs for HS management is increasing, and treatment will be based on a tailored-tail approach, minimizing the risk of adverse events. In this context, we want to point out the reported effectiveness and safety data concerning adalimumab, ustekinumab and secukinumab as well as ixekizumab.