Paradoxical Hidradenitis Suppurativa in Patients Receiving TNF-α Inhibitors: Case Series, Systematic Review, and Case Meta-Analysis

Abstract

Background/Aims: TNF-α inhibitors represent the most advanced approved therapeutic option for moderate and severe forms of hidradenitis suppurativa (HS). However, in recent years, cases of paradoxical HS secondary to the use of these biological drugs have been described, with very few cases reported in the literature. The aims of this study are (1) to present 2 new cases of paradoxical HS and (2) to perform a systematic review of scientific evidence regarding paradoxical HS with TNF-α inhibitors. Material and Methods: This is a retrospective study in which we searched all the cases of paradoxical HS secondary to the use of TNF-α inhibitors published in the literature and included two additional cases observed in our clinical practice. Results: A total of 34 patients under TNF-α inhibitor treatment were included (adalimumab = 21; infliximab = 9; etanercept = 4). The median delay from exposure to TNF-α inhibitor and the development of paradoxical HS was 12 months (range 1–72). The majority of patients were Hurley stage II (58.8%). Clinical improvement and complete remission were more frequent when the TNF-α inhibitor was stopped or switched to another biological agent with a different therapeutic target rather than maintenance or change to another TNF-α inhibitor. Conclusions: Paradoxical HS is an unusual adverse effect of TNF-α inhibitors. When this adverse effect appears, interruption or substitution of treatment is associated with a better clinical outcome.

<p>Hidradenitis Suppurativa as a Paradoxical Side Effect to the Use of Adalimumab in Patients with Crohn’s Disease?</p>

“…Analogous to our results, females were the dominant gender in these studies. [3][4][5] Other adalimumab risk factors, such as smoking and obesity, 23 were not observed in the present study.…”

“…22 A relationship between the use of adalimumab and the appearance of HS as a paradoxical effect of the medication has previously been reported. [3][4][5] Faivre et al 3 conducted a retrospective study on 25 patients with auto-immune diseases (9 CD). In this study, 12 patients, who were treated with adalimumab, developed HS.…”

“…In these cases, it is indicated to switch or stop the anti-TNF. 5 Anti-TNF should be maintained only in cases where the therapy is essential or exchange is not possible. 5 In all cases, specific treatment for HS must be added.…”

“…1,2 However, hidradenitis suppurativa (HS) has been described as a possible paradoxical effect of adalimumab. [3][4][5] HS is an immune-mediated inflammatory disease, that involves the pilosebaceous structure, and typically presents as phlogistic, deep, and painful lesions. 6 Nodes, recurrent painful abscesses, fistulas and scars have also been associated with HS.…”

“…8 However, cases of paradoxical HS secondary to the use of biological agents have been described in the literature. [3][4][5] This study reports on three patients with CD, who were treated with adalimumab, and subsequently exhibited HS.…”