Hidradenitis suppurativa: are tumour necrosis factor-α blockers the ultimate alternative?

Abstract

and duration by 826 (69AE0%) of all patients; methotrexate was used by fewer than half of the patients (531, 44AE4%). Response to phototherapy was insufficient in 79AE0% of all cases. In contrast, ciclosporin and methotrexate had sideeffects or were contraindicated in more than 65% of the patients. The relatively infrequent use of ciclosporin and methotrexate may have resulted from the fact that many patients actually did receive these therapies, but did not completely fulfil the required criteria for dosage and treatment duration. Remarkably, methotrexate was used by fewer than half of the patients. This may be due the fact that patients did not reach the required dosage of 22AE5 mg per week, because of side-effects at lower dosage. Furthermore, many patients with psoriasis requiring systemic treatment may be successfully treated with methotrexate, and consequently do not need biological therapy.In total, 1254 (94AE5%) of all initial treatment applications and 812 of all follow-up applications were approved by LABAG. This validates the conclusion that dermatologists are familiar with the demanded criteria for reimbursement of biological therapies. 2 The remaining 442 follow-up applications were not received or were rejected, mainly as a result of a < 50% decrease in PASI at week 12.A PASI 50 response at week 12 was achieved by 69AE0% of all patients with an approved initial treatment application for etanercept, and by 50AE0% of all patients with an approved initial treatment application for efalizumab. These results are slightly lower than randomized controlled trial data (etanercept 76%, efalizumab 55%), 3 but are comparable with the results of daily practice cohort studies, in which the efficacy of etanercept and efalizumab treatment in daily practice were evaluated. 4,5 The mean reduction in PASI relative to baseline at week 12 was 53AE1% for etanercept, compared with 35AE5% for efalizumab, after carrying forward the baseline PASI to week 12 in cases of missing follow-up PASI. When analysing only 'responding' patients, i.e. patients with approved initial and follow-up applications, mean reduction in PASI relative to baseline was 75AE0% and 68AE3% for etanercept and efalizumab, respectively (Table 2). However, in the first analysis treatment efficacy is underestimated, whereas the second analysis leads to an overestimation of treatment efficacy. The real values should be in between the results of both analyses.Three times more applications were received for etanercept than efalizumab. Apparently, dermatologists have a preference for etanercept as first-choice biological therapy. The fact that etanercept is approved for the treatment of psoriatic arthritis as well, whereas efalizumab is not, might account for this. 6 Furthermore, according to the presented data, the efficacy of etanercept is superior to that of efalizumab. However, the presented data are unsuitable for objective comparison between etanercept and efalizumab.The present analysis demonstrates that, as a consequence of strict adherence to reimbur...

The Effect of Combined Treatment with Oral Clindamycin and Oral Rifampicin in Patients with Hidradenitis Suppurativa

“…A significant proportion of HS lesions appear to be sterile [7, 8], and anti-inflammatory therapy with e.g. cyclosporine [18], dapsone [19], methotrexate [20], prednisone [21] or biologicals [22] has been described as an alternative therapy to antibiotics in HS. Moreover, besides their bactericidal effects the antibiotics used in the treatment of HS also have immunomodulatory properties [23], suggesting that the latter property is also responsible for their beneficial effect in HS.…”

Medical and Surgical Treatment of Hidradenitis Suppurativa: A Review

“…As regards infliximab, even if the first RCT phase II crossover study on 38 patients (15 treated and 28 placebo) was published in 2010 [25,] no additional phase III RCT studies have been published. A cumulative response rate of 58% (improvement ≥50% in 42 patients) has been reported in case reports with 73 patients with moderate to severe HS [107,108,109,110,111,112,113,114,115,116]. Infliximab is administered intravenously over a period of 2 h, whereas adalimumab is administered subcutaneously.…”

Management of Hidradenitis Suppurativa with Biological Therapy: Report of Four Cases and Review of the Literature

“…As a prominent side effect, we found in the literature a case of bilateral Candida chorioretinitis in a patient with HS treated with etanercept [30]. The efficacy of infliximab in HS is consistently reported, as shown in table 4, often coinciding with Crohn's disease (cases summarized in table 4) [31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60]. In these last cases, it has been postulated that the improvement could be due to the similarity between the two diseases.…”

“…Similarly, Brunasso and Massone [65] described in a new article the loss of efficacy of infliximab in two of their previously reported patients (summarized in table 5) [56], who had had an excellent response to infliximab at week 12, maintained through week 74 and 82 in each of them. They conducted a therapeutic change in the first case with poor response to adalimumab at week 24, with a subsequent change to etanercept achieving a sustained response of 88 weeks.…”