Biologic Use in Pediatric Patients With Hidradenitis Suppurativa: A Systematic Review

Abstract

Background: There is currently at least 1 biologic (adalimumab) approved in North America for treatment of Hidradenitis Suppurativa in the pediatric population. However, no reviews or clinical trials have specifically analyzed the effectiveness and safety data of biologic use in this population. The objective of this systematic review is to identify and summarize the outcomes of biologic therapy in pediatric patients with HS. Methods: MEDLINE and EMBASE databases were used to conduct the search on Sept 18, 2020. Results: The 15 included studies consisted of 26 patients, with the mean age of 15 ± 2.3 years. Females accounted for 53.8% ( n = 14/26) of cases. The mean duration of HS prior to biologic initiation was 3.5 ± 2.9 years, with the majority having Hurley Stage II. The 26 patients received 34 biologics in total: 85.3% treated with TNF alpha inhibitors (adalimumab n = 17, infliximab n = 10, etanercept n = 1, unspecified n = 1), 5.9% with IL-12/23 inhibitors (ustekinumab n = 2), 5.9% with IL-1 inhibitors (i.e., anakinra n = 2) and 2.9% received IL-23 inhibitors (i.e., guselkumab n = 1) biologics. Of the 26 patients, 23.1% ( n = 6/26) experienced complete resolution (CR), 73.1% ( n = 19/26) experienced partial resolution (PR), and 3.8% ( n = 1/26) had no resolution outcomes reported. The time to resolution of HS lesions after biologic initiation ranged from 10 days to 11.5 months (mean: 5.1 months). No adverse events were reported in the studies. Conclusion: Although anti-TNF alpha were the most common biologics used for HS in pediatric cases, large-scale trials specific to pediatric patients with HS are needed to confirm these findings.

Caring for Pediatric Hidradenitis Suppurativa Patients in the Emergency Department

“…The US Food and Drug Administration has approved the use of adalimumab in patients 12 years or older, with a dosing regimen of 40 mg every other week or 40 mg every week for obese or refractory adolescents. 18 A recent review of MEDLINE and EMBASE databases identified 12 pediatric HS patients treated with biologic treatment with good response. Seven patients experienced complete resolution of their HS, whereas 5 patients had partial resolution.…”

“…18 A case report described a 16-year-old adolescent girl who showed strong clinical and psychological improvement with adalimumab use for 4 years, with no adverse effects. 18 Literature on infliximab or etanercept use in pediatric HS is scarce, but in a case series, 1 pediatric patient demonstrated subjective improvement with etanercept. 18 Although oral steroids and methotrexate are used in the adult literature, these medications are not typically used in pediatric HS unless the presentation is severe.…”

“…18 Literature on infliximab or etanercept use in pediatric HS is scarce, but in a case series, 1 pediatric patient demonstrated subjective improvement with etanercept. 18 Although oral steroids and methotrexate are used in the adult literature, these medications are not typically used in pediatric HS unless the presentation is severe.…”

“…Although there have been no randomized controlled trials evaluating the effectiveness of biologics in children with HS, tumor necrosis factor α inhibitors are considered first-line treatment in adults with moderate to severe disease. The US Food and Drug Administration has approved the use of adalimumab in patients 12 years or older, with a dosing regimen of 40 mg every other week or 40 mg every week for obese or refractory adolescents 18 . A recent review of MEDLINE and EMBASE databases identified 12 pediatric HS patients treated with biologic treatment with good response.…”

“…Seven patients experienced complete resolution of their HS, whereas 5 patients had partial resolution 19 . In a case series, 2 pediatric patients demonstrated a reduction in the number of affected areas and improved quality of life after treatment with adalimumab 18 . A case report described a 16-year-old adolescent girl who showed strong clinical and psychological improvement with adalimumab use for 4 years, with no adverse effects 18 .…”