14970 Short-lived efficacy of ertapenem for refractory hidradenitis suppurativa

Nosrati, Avigdor; Babbush, Kayla M.; Ghias, Mondana; Pacific, Kristen; Hosgood, H. Dean; Cohen, Steven R.

doi:10.1016/j.jaad.2020.06.186

Cited by 3 publications

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“…In the HS cohort, IV ertapenem for a mean (SD) of 13.1 (4.0) weeks was associated with substantial declines in both disease severity scores and inflammatory markers. Continued remediation of disease was documented for a mean (SD) of 54.4 (25.2) days, demonstrating both sustained efficacy and durability of response when compared to the immediate recurrence of disease previously after a shorter course of 6 weeks . These findings suggest a course of 12 to 16 weeks of ertapenem may be appropriate as a new standard length of therapy in HS patients, which is at least twice the current recommendation of North American treatment guidelines …”

Section: Discussionmentioning

confidence: 72%

“…In 2019, we reported short-lived efficacy after 6 weeks of ertapenem for refractory HS; this duration is the current standard of care recommended in the North American treatment guidelines for HS . Recurrent disease activity and pain severity within 4 weeks of discontinuing ertapenem led us to explore the durability of HS remissions after longer treatment intervals.…”

Section: Discussionmentioning

confidence: 99%

“…Since 2015, multiple studies and case reports have demonstrated the efficacy of ertapenem for recalcitrant HS . We previously described the efficacy of daily IV ertapenem for 6 weeks in 7 patients with HS experiencing notable remediation of disease that was rapidly lost within 1 month of withdrawal . Given these findings, we sought to explore the outcomes of a longer duration of treatment with ertapenem as an adjunct therapy in treating HS.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and Durability of Intravenous Ertapenem Therapy for Recalcitrant Hidradenitis Suppurativa

Nosrati,

Ch’en,

Torpey

et al. 2024

JAMA Dermatol

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ImportanceHidradenitis suppurativa (HS) is a debilitating follicular skin disorder in which bacterial colonization is typical. Oral antibiotic efficacy can be unreliable; however, selective intravenous antibiotics, specifically ertapenem, may provide favorable clinical outcomes.ObjectiveTo explore optimal course duration, efficacy, and patient satisfaction associated with intravenous ertapenem for HS.Design, Setting, and ParticipantsThis retrospective review of the medical records of 98 patients with HS between 2018 and 2022 measured and evaluated patient outcomes before and after treatment with intravenous ertapenem. Participants were followed up in a telephone survey assessing patient perspectives and satisfaction. All of those included in this study received medical care from the Albert Einstein College of Medicine’s Montefiore HS Center.ExposuresPatients were treated with 1 g of ertapenem that was self-administered at home through a peripheral intravenous central catheter using an elastomeric pump for 12 to 16 weeks. Antiandrogens and immunomodulatory biologic therapies initiated prior to ertapenem were maintained throughout the treatment course.Main Outcomes and MeasuresThe primary outcomes, encompassing clinical severity (evaluated through the HS Physician Global Assessment score [a 6-point scale ranging from clear to very severe] and a numerical rating scale for pain [an 11-point scale in which a score of 0 indicates no pain and a score of 10 indicates the worst possible pain]) and markers of inflammation (such as leukocytes, erythrocyte sedimentation rate, C-reactive protein, and interleukin-6), were measured at baseline, the midcourse of intravenous ertapenem treatment, at the end of the course, and posttherapy. Bacterial abundance was also examined at these 4 points, and patient satisfaction was assessed during follow-up.ResultsA total of 98 patients (mean [SD] age, 35.8 [13.0] years; 61 [62.2%] female) with HS were treated with intravenous ertapenem. The self-reported racial distribution included 3 individuals identifying as Asian (3.1%), 59 as Black/African American (60.2%), 13 as White (13.3%), and 23 as either other or unknown (23.5%). Additionally, 24 participants (24.5%) reported Spanish/Hispanic/Latino ethnicity. The mean (SD) treatment duration spanned 13.1 (4.0) weeks, with posttherapy follow-up occurring after 7.8 (3.6) weeks. From baseline to posttherapy follow-up, significant reductions were found in the mean (SD) HS Physician Global Assessment scores (3.9 [1.0] vs 2.7 [1.2]; P &lt; .001) and the numerical rating scale for pain (4.2 [3.3] vs 1.8 [2.7]; P &lt; .001), C-reactive protein (5.4 [11.4] vs 2.4 [2.0] mg/dL; P &lt; .001), interleukin-6 (25.2 [21.1] vs 13.7 [13.9]; P &lt; .001), and leukocytes (11.34 [3.9] vs 10.0 [3.4]; P &lt; .001). At follow-up, 76 patients (78.0%) participated in the telephone survey, where 63 (80.3%) reported medium to high satisfaction; further, 69 (90.8%) would recommend ertapenem to other patients.Conclusions and RelevanceIn this retrospective review of medical records and telephone survey, treating HS with intravenous ertapenem, administered for a mean of 13 weeks, was associated with improvement in clinical and inflammatory markers, as well as heightened patient satisfaction. Nonetheless, this approach should be monitored for the emergence of antimicrobial resistance given a longer than standard treatment course.

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Efficacy and Durability of Intravenous Ertapenem Therapy for Recalcitrant Hidradenitis Suppurativa

Nosrati,

Ch’en,

Torpey

et al. 2024

JAMA Dermatol

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“…The current multi-tiered treatment algorithm combines topical, oral, and intravenous antibiotics, anti-androgen therapy, and immunomodulators that target mediators of inflammation. [3][4][5] No single treatment has proved effective for all patients. 6 The most common immunomodulators used for HS are adalimumab and infliximab.…”

Section: Introductionmentioning

confidence: 99%

“…Advanced HS is extremely challenging to treat. The current multi‐tiered treatment algorithm combines topical, oral, and intravenous antibiotics, anti‐androgen therapy, and immunomodulators that target mediators of inflammation 3–5 . No single treatment has proved effective for all patients 6…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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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.

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Importance of a multi-tiered treatment approach for intellectually and developmentally disabled patients with hidradenitis suppurativa

Nosrati

Torpey

Andriano

et al. 2022

Preprint

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Introduction Hidradenitis suppurativa (HS) is a chronic, debilitating skin condition that is characterized by painful pustules, nodules, abscesses, and sinus tracts. The complicated and fast-evolving treatment of HS consists of a multi-tiered approach that includes, antibacterial, antihormonal, anti-inflammatory, and surgical options. Studies have demonstrated an earlier age of onset and increased prevalence of HS in patients with intellectual and developmental disorders (IDD) compared to patients without IDD’s. Objectives To explore the use of an intensive multi-tiered HS management algorithm that requires monthly office visits, monthly intravenous therapy, and several daily treatment modalities in an HS population with IDD’s. Methods We conducted an IRB-approved retrospective chart review of HS patients treated at the Albert Einstein College of Medicine-Montefiore HS Center (HSC) with diagnoses of concurrent IDD to investigate their demographic and diagnostic characteristics, as well as the spectrum of therapies employed in this cohort. Results A total of 22 HS patients with concomitant IDD’s including trisomy 21, unspecified intellectual disability, autism spectrum disorder, and trisomy 13 were identified. Therapies utilized in this cohort for HS included topical and oral antibiotics, spironolactone, finasteride, oral contraceptive pills, infliximab, adalimumab, isotretinoin, intralesional and intramuscular triamcinolone injections, and excisional surgery. Conclusion In conclusion, our findings indicate that despite the practical challenges, daily oral antibiotic regimens, anti-androgen combinations, oral retinoids, infliximab, adalimumab, and surgery collectively play important roles in treating HS patients with IDD. Our cases underscore the importance of utilizing the full range of modalities as the HS treatment algorithm continues to evolve.

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14970 Short-lived efficacy of ertapenem for refractory hidradenitis suppurativa

Cited by 3 publications

References 0 publications

Efficacy and Durability of Intravenous Ertapenem Therapy for Recalcitrant Hidradenitis Suppurativa

Efficacy and Durability of Intravenous Ertapenem Therapy for Recalcitrant Hidradenitis Suppurativa

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

Importance of a multi-tiered treatment approach for intellectually and developmentally disabled patients with hidradenitis suppurativa

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