Interventions for hidradenitis suppurativa: a Cochrane systematic review incorporating GRADE assessment of evidence quality

Abstract

SummaryMore than 50 interventions have been used to treat hidradenitis suppurativa (HS), and so therapy decisions can be challenging. Our objective was to summarize and appraise randomized controlled trial (RCT) evidence for HS interventions in adults. Searches were conducted in Medline, Embase, CENTRAL, LILACS, five trials registers and abstracts from eight dermatology conferences until 13 August 2015. Two review authors independently assessed study eligibility, extracted data and assessed methodological quality. Primary outcomes were quality of life and adverse effects of the interventions. Twelve trials, from 1983 to 2015, investigating 15 different interventions met our inclusion criteria. The median trial duration was 16 weeks and the median number of participants was 27. Adalimumab 40 mg weekly improved the Dermatology Life Quality Index (DLQI) by 4·0 points, which equates to the minimal clinically important difference for the scale, compared with placebo (95% confidence interval −6·5 to −1·5 points). Evidence quality was reduced to ‘moderate’ because the results are based on only a single study. Adalimumab 40 mg every other week was ineffective in a meta‐analysis of two studies comprising 124 participants. Infliximab 5 mg kg−1 improved the DLQI score by 8·4 points after 8 weeks in a moderate‐quality study completed by 33 of 38 participants. Etanercept 50 mg twice weekly was ineffective. Inclusion of a gentamicin sponge prior to primary closure did not improve outcomes. Other interventions, including topical and oral antibiotics, were investigated by relatively small studies, preventing treatment recommendations due to imprecision. More, larger RCTs are required to investigate most HS interventions, particularly oral treatments and surgical therapy. Moderate‐quality evidence suggests that adalimumab given weekly and infliximab are effective, whereas adalimumab every other week is ineffective.

Interventions for rosacea

“…3 Topical clindamycin is most frequently utilized for management of acne vulgaris and treatment of bacterial vaginosis, although it has been used off-label for controlling a variety of other dermatologic conditions, including rosacea and hidradenitis suppurativa. 4,5 The two most common formulations are clindamycin hydrochloride and clindamycin phosphate; ACD to both preparations have been reported (Table S1). 6,7 Given that topical clindamycin is often indicated for long-term use, it is interesting that sensitization is rare.…”

T helper 17 cell/regulatory T-cell imbalance in hidradenitis suppurativa/acne inversa: the link to hair follicle dissection, obesity, smoking and autoimmune comorbidities

“…Targeted immune therapy has recently been introduced for the management of HS. [122][123][124][125][126][127][128][129][130][131][132][133]…”

“…133,193 Six agents, namely adalimumab, anakinra, etanercept, infliximab, ustekinumab and secukinumab, have been explored in the setting of HS treatment. 125 Among anti-TNF-a drugs, adalimumab and infliximab seem to obtain satisfactory results in HS. 193 Complete and persistent resolution of HS is rarely achieved.…”

Hospitalisations with Hidradenitis Suppurativa: An Increasing Problem That Deserves Closer Attention

“…In spite of its great impact both on personal and social perspectives [8,9] , the available treatments, surgical and medical ones, have variable and unpredictable efficacy [1,10,11] .…”