Efficacy and safety of adalimumab in hidradenitis suppurativa

Abstract

Background: Adalimumab is used as a first-line biologic agent in the management of moderate-to-severe hidradenitis suppurativa (HS). The objective of the present study was to evaluate the efficacy and safety of adalimumab in patients with moderate-to-severe HS. Methods: We performed a systematic review and meta-analysis according to Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines. Pooled estimates, namely standardized mean difference (SMD) and relative risk (RR), were calculated using random-effect model with trial sequential analysis. Small study effects were examined using the Doi plot. Certainty of evidence (CoE) was assessed using “The Grading of Recommendations Assessment, Development, and Evaluation” approach, and number-needed-to-treat (NNT) was calculated. Results: Five randomized controlled trials, involving 1014 patients, were included. We performed subgroup analysis of adalimumab administered subcutaneously both weekly and every other week. Adalimumab administered weekly was associated with better clinical response achievement (RR 1.76, 95% confidence interval [95% CI] 1.35–2.29; trial sequential analysis TSA-adjusted CI 1.01–3.08; CoE: low; NNT = 5) and a significant improvement in modified Sartorius score (SMD = −0.45, 95% CI = −0.76 to −0.13; CoE: very low; NNT = 10) and dermatology life quality index (DLQI) (SMD −0.47, 95% CI −0.61 to −0.32; CoE: low; NNT = 10). Nevertheless, adalimumab administered every other week showed an improvement only in modified Sartorius score. The pooled RRs of adverse events in both groups revealed no statistical significance when compared with the placebo. Conclusions: Adalimumab administered weekly resulted in not only better clinical responses than placebo but also significantly improved disease severity and quality of life of patients with moderate-to-severe HS. Our study provides supporting evidence to the current guidelines and aids decision-making in the application of adalimumab in HS management.

Insights into the Pathogenesis of HS and Therapeutical Approaches

“…In a recent systematic review and meta-analysis of five randomized controlled trials (involving 1014 patients), Lu and colleagues evaluated the efficacy and safety of ADA in HS. The authors confirmed that ADA administered weekly showed not only an improvement in clinical response (compared to placebo) but also in symptoms and quality of life of moderate-to-severe HS patients [ 180 ]. Concerning long-term ADA efficacy in moderate-to-severe HS patients, a 3-year open-label extension of PIONEER I and II revealed that a sustained response (HiSCR) was maintained in 52.3% of patients treated with ADA, 40 mg per week, through to week 168 [ 181 ].…”

Current Medical and Surgical Treatment of Hidradenitis Suppurativa—A Comprehensive Review

“…Adalimumab can be administered in subcutaneous injections in two treatment regimens with 40 mg every week or 80 mg every other week after an initial loading dose [ 20 ]. The therapy is usually well tolerated with injection side reactions being the most common side effects and large meta-analyses have shown non-significant safety issues compared to placebo [ 118 ]. In very rare cases malignancies (esp.…”

Efeitos do Adalimumabe, Clindamicina e/ou Rifampicina no Tratamento da Hidradenite Supurativa: Um Protocolo de Revisão Sistemática

“…Among these, adalimumab stands out as a tumor necrosis factor-alpha antagonist indicated not only for the treatment of HS but also for other high prevalence diseases such as rheumatoid arthritis, psoriasis, and Crohn's disease (7) . Adalimumab is a recent therapeutic alternative for HS that has demonstrated satisfactory efficacy in treating the disease, particularly with the potential to reduce inflammatory nodules within 12 weeks and improve the quality of life in patients diagnosed with moderate to severe clinical presentations (8,9) . However, the information available on its effects varies widely in the literature in terms of study design, outcomes, and comparators.…”

“…However, the information available on its effects varies widely in the literature in terms of study design, outcomes, and comparators. Although there is a systematic review of randomized clinical trials testing the effects of adalimumab on HS (9) , there is still no systematic evidence review that includes and compares the most common topical and biologic alternatives for HS treatment, covering both experimental and real-world approaches. Conducting a study with such characteristics will advance knowledge for therapeutic decision-making based on the synthesis of robust evidence encompassing the available alternatives for the treatment of HS.…”