Adalimumab efficacy is inversely correlated with body mass index (BMI) in hidradenitis suppurativa

Abstract

Background Adalimumab is the only FDA‐approved biologic for hidradenitis suppurativa (HS). In the setting of increasing obesity rates worldwide, the relationship between adalimumab efficacy for HS and BMI is essential to understand. We assessed this relationship through markers of disease severity and inflammation. Methods Institutional review board‐approved retrospective chart review of Montefiore/Einstein HS Center (HSC) patients (n = 57) treated with adalimumab. The relationship between BMI and adalimumab efficacy was assessed through disease severity (HS‐Physician Global Assessment [HS‐PGA] 0 and Numerical Rating Scale Pain [NRS‐Pain]) and inflammatory markers (erythrocyte sedimentation rate [ESR], C‐reactive protein [CRP], and interleukin‐6 [IL‐6]). A BMI ≥ 30 is defined as obese; BMI < 30 is defined as non‐obese. Results The mean age was 35.8 ± 13.0 years. After adalimumab therapy, those with BMI < 30 experienced significant reductions in HS‐PGA (−1.5 ± 0.9; P < 0.0001) and NRS‐Pain (−1.6 ± 2.1; P < 0.0001), as well as mean decreases in inflammatory markers ESR, CRP, and IL‐6 (−17.90 ± 23.6, −0.71 ± 1.4, −5.88 ± 7.9, respectively; P > 0.05). Obese patients (BMI ≥ 30) experienced mean increases in HS‐PGA (+0.22 ± 0.8; P > 0.05) and NRS‐Pain scores (+1.41 ± 3.5; P > 0.05) as well as mean increases in ESR, CRP, and IL‐6 (+2.62 ± 28.3, +0.44 ± 3.0, +2.35 ± 6.9, respectively; P > 0.05). Comparing the cohorts, differences in changes in HS‐PGA, NRS‐Pain, ESR, and IL‐6 after therapy are significantly different (P < 0.05). Conclusions We identified significantly lower efficacy of adalimumab in HS patients with BMI ≥ 30 compared to those with BMI < 30. Those with BMI ≥ 30 demonstrated signs of both clinical and physiological deterioration while on adalimumab. Future studies are needed to examine adalimumab dosing for HS patients with high BMI, as well as a critical reconsideration of weight‐based therapies.

Gram‐negative anaerobes elicit a robust keratinocytes immune response with potential insights into HS pathogenesis

“…Antibiotics have long been a mainstay of HS treatment in early disease 61 . In a recent trial, ertapenem, a potent bactericidal antibiotic was shown to reduce HS inflammatory disease activity as well as reduction of IL‐6 and CRP 62 . Recently published clinical data in HS also demonstrated the clinical benefit of combining rifampicin/clindamycin with adalimumab, 63 as well as alternatively using anti‐biofilm surfactant wound gels during surgery with high clinical response 64 and reductions of inflammatory genes like IL‐17, IL‐6 and IL8.…”

Enfermedad anal en pacientes candidatos a cirugía bariátrica: estudio descriptivo

“…Además, la obesidad interfiere negativamente en la efectividad de los nuevos tratamientos para la hidrosadenitis supurativa. Nosrati et al 27 demuestra que los pacientes con un IMC >30 sufren un deterioro físico-clínico a pesar del tratamiento completo con Adalimumab. Teniendo en cuenta lo referido anteriormente, no es de extrañar que las nuevas líneas de investigación reconsideren una terapia basada en el peso para el manejo de esta patología.…”

Balancing Ertapenem Therapy in Recalcitrant Hidradenitis Suppurativa With Antibiotic Stewardship

“…In this issue of JAMA Dermatology , the cohort study by Nosrati et al provides evidence supporting the extension of intravenous ertapenem therapy to an average course duration of 13 weeks for HS recalcitrant to combinations of broad-spectrum oral antibiotics, antiandrogen therapies, and immunomodulating biologics. Although this investigation advances treatment options for the vexing problem of recalcitrant HS, adopting prolonged ertapenem treatment courses comes with substantial individual and public health considerations.…”

“…The study’s limitations must also be carefully considered when interpreting these findings . The authors used the HS Physician Global Assessment to measure disease improvement; however, the average reduction in score fell short of the accepted clinically meaningful threshold of a 2-point decrease.…”

“…Although these findings suggest that prolonged courses of ertapenem may be a promising therapy for recalcitrant HS, prospective studies are needed to understand its true efficacy and risks, especially with other potential concomitant therapies that these patients are likely to be receiving. Gaining insights into the mechanisms by which ertapenem improves HS may deepen understanding of the condition, offering the potential for the development of more effective, novel therapies for HS.…”