Adalimumab Dose Intensification in Recalcitrant Hidradenitis Suppurativa/Acne Inversa

Abstract

Background: Adalimumab is the only approved compound for the treatment of adult patients with moderate-to-severe hidradenitis suppurativa (HS) who did not respond to a systemic classical treatment. Despite its significant short- and long-term efficacy, a percentage of patients do not respond sufficiently. Moreover, some primary responders experience a response loss with time. Objective: To analyse the effectiveness of adalimumab dose intensification in HS patients. Methods: A case series of adalimumab 80 mg/week subcutaneously (s.c.) compassionate use in patients with HS, who did not respond sufficiently or in primary responders with progressive response loss to the registered adalimumab dose of 40 mg/week s.c. Patients were collected and evaluated retrospectively. Patients’ data were extracted from medical records. Results: The 14 patients collected were Caucasian with HS of Hurley stage II–III and moderate or severe International HS Severity Score System (IHS4) stage. Adalimumab dose intensification significantly improved IHS4 score, Pain Index, HS-Physician Global Assessment, pain, and Cardiff Dermatology Life Quality Index. Two young female patients with HS and Crohn’s disease developed psoriatic lesions during the treatment with adalimumab 80 mg/week s.c. Conclusion: An enhanced level of effectiveness was assessed in the majority of the HS patients treated with adalimumab dose intensification (80 mg/week s.c.). Larger studies are required to evaluate this observation.

What causes hidradenitis suppurativa ?—15 years after

“…Generally, effective treatment of HS with targeted anti-TNF agents has required higher doses than other skin diseases even with weight-based dosing. 193,194 Moreover, the cytokine profile of lesional skin suggests tamping down other parts of the inflammatory cascade simultaneously could be useful. In any event, the number of effective agents currently under study is enormously encouraging and will lead us to better understand the disease and help our patients.…”

Race and Ethnicity Gaps in Global Hidradenitis Suppurativa Clinical Trials

“…It still remains unclear whether sociodemographic and cultural characteristics play a role in developing HS [4, 5]. HS remains difficult to treat [6] and biomarkers capable of predicting drug response are crucial in order to further personalize treatment options. If personalization of the therapy is a prominent goal to achieve, generalizability of therapeutics is of paramount importance.…”

Kyrle disease associated with hidradenitis suppurativa successfully treated with tumour necrosis factor inhibition

“…The efficacy and safety of adalimumab in treating HS are largely demonstrated, whereas no evidence of its off-label use in treating KD has been reported. 3,4 In our case, KD associated with HS was successfully treated with adalimumab. Adalimumab was administered at the recommended dose for HS therapy, leading to the resolution of the clinical symptoms of KD and complete remission of HS.…”