Systemic antibiotics in hidradenitis suppurativa: efficacy and effects of body mass index and smoking pack‐year on the response to therapy

Abstract

The combination of oral clindamycin with rifampicin is recommended by European guidelines as a first‐line treatment in moderate‐to‐severe hidradenitis suppurativa (HS). Recent studies highlight that oral clindamycin in monotherapy (CM) may be a useful alternative treatment. We included 36 patients with a diagnosis of moderate‐to‐severe HS. A total of 19 patients were treated with combination oral clindamycin plus rifampicin (C + R) and 17 with oral CM for 12 weeks. The efficacy of CM vs C + R was analyzed by multilinear regression models which showed a higher reduction in mSartorius (Δ = −13.2, P = .058) and AISI (Δ = −4.91, P = .034) in the C + R group. In the C + R group, smoking pack‐year was positively correlated with AISI (Spearman's rho = 0.51, P = .036) and with DLQI (0.47, P = .061). In the CM group, a positive correlation was found between BMI and AISI (0.47, P = .041). The data on the efficacy of C + R combination therapy are in line with guidelines, evidence‐based approaches, and recommendations from the HS ALLIANCE working group. The rationale for combining these two drugs is to increase bactericidal action and to reduce rifampicin resistance, as rifampicin is highly mutagenic. Our results suggest that the antibiotic combination of C + R is still the treatment of choice in moderate‐to‐severe HS with abscesses, draining fistulae and ≥ 5 inflammatory nodules. High BMI and smoking habits seem to be predictive factors of a poor response to antibiotics. Further multicenter studies and prospective randomized controlled trials are needed to confirm these results. Potential alternative antibiotic therapies should also be investigated.

Retrospective Cohort Study on Asian Patients with Hidradenitis Suppurativa: Factors Associated with the Efficacy of Antibiotic Treatment

“…Obesity and DM are more prevalent in patients with HS than in those without HS ( 9 ). A retrospective study of 36 patients with HS by Iannone et al ( 11 ) stated that high body mass index (BMI) and smoking seemed to be predictive factors for poor treatment response to antibiotics. However, according to the multivariate analysis demonstrated in our study, obesity was not significantly associated with treatment response.…”

“…IHS4 measures HS severity by assessing inflammatory nodules, abscesses, and draining fistulas ( 5 ). Antibiotics are more effective against nodule and abscess than against fistula ( 11 ). In our study, IHS4 total score, which reflects the severity of inflammatory lesions, correlated well with patients’ response to first-line antibiotic treatment.…”

New perspectives on the treatment of hidradenitis suppurativa

“…Clindamycin and rifampicin used at a dose of 300 mg twice daily have been proven effective in HS in several observational studies 65,67–69 and are considered a first-line and second-line treatment for HS. A systematic review of retrospective and prospective series reported response rates from 71% to 93% in 187 patients, strongly favoring their use.…”

“…65 Likewise, a retrospective study comparing the efficacy of lymecycline (300 mg daily) versus the combination therapy clindamycin and rifampicin (600 mg plus 600 mg daily) during 10 weeks in 52 patients (26 per group) observed a 57.7% and 53.8% HiSCR achievement, respectively. 66 Clindamycin and rifampicin used at a dose of 300 mg twice daily have been proven effective in HS in several observational studies 65,[67][68][69] and are considered a first-line and second-line treatment for HS. A systematic review of retrospective and prospective series reported response rates from 71% to 93% in 187 patients, strongly favoring their use.…”

Safety and efficacy of the BNT162b2 mRNA COVID-19 vaccine during Ixekizumab treatment for hidradenitis suppurativa

“…Hidradenitis suppurativa (HS) is a chronic relapsing skin inflammatory disease. The therapeutic management of HS is based on immunosuppressive therapies (steroids, dapsone, cyclosporine) or immunomodulatory therapies (antibiotics or biological drugs) 3 . The Hidradenitis Suppurativa Foundation from North America experts (HSF), based on real-life data and pathogenetic mechanisms of lethal COVID-19 cases, recommend to continue current biological treatment such as TNF-α, IL-12/IL-23 and IL-17 inhibitors suspending treatment only in case of COVID-19 suspicious symptoms 4 .…”