High-dose, high-frequency infliximab: A novel treatment paradigm for hidradenitis suppurativa

Ghias, Mondana; Johnston, Andrew D.; Kutner, Allison; Micheletti, Robert G.; Hosgood, H. Dean; Cohen, Steven R.

doi:10.1016/j.jaad.2019.09.071

Cited by 54 publications

(55 citation statements)

References 32 publications

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“…Generally, effective treatment of HS with targeted anti-TNF agents has required higher doses than other skin diseases even with weight-based dosing. 193,194 Moreover, the cytokine profile of lesional skin suggests tamping down other parts of the inflammatory cascade simultaneously could be useful. In any event, the number of effective agents currently under study is enormously encouraging and will lead us to better understand the disease and help our patients.…”

Section: Pathog Ene S Is -A Sso Ciated Future Ther Apie Smentioning

confidence: 99%

“…As both targeted and multimodality approaches are tested, it will be interesting to see whether, given the high inflammatory load, a multimodality approach is more effective for induction, and more targeted approaches are useful for maintenance. Generally, effective treatment of HS with targeted anti‐TNF agents has required higher doses than other skin diseases even with weight‐based dosing 193,194 . Moreover, the cytokine profile of lesional skin suggests tamping down other parts of the inflammatory cascade simultaneously could be useful.…”

Section: Pathogenesis‐associated Future Therapiesmentioning

confidence: 99%

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What causes hidradenitis suppurativa ?—15 years after

Zouboulis

Benhadou

Byrd

et al. 2020

Experimental Dermatology

104

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Section: Pathog Ene S Is -A Sso Ciated Future Ther Apie Smentioning

confidence: 99%

Section: Pathogenesis‐associated Future Therapiesmentioning

confidence: 99%

What causes hidradenitis suppurativa ?—15 years after

Zouboulis

Benhadou

Byrd

et al. 2020

Experimental Dermatology

104

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“…In terms of HS therapy, biologic agents, particularly targeting tumour necrosis factor alpha (TNFα), are now an integral part of the management of moderate to severe disease [79][80][81]. Although clinical benefit has been reported with several biologics, including infliximab [82], ustekinumab [83] and secukinumab [84], only adalimumab is licensed at present for the treatment of moderate to severe HS.…”

Section: The Cutaneous And/or Gastrointestinal Microbiomes As a Theramentioning

confidence: 99%

The Role of the Cutaneous Microbiome in Hidradenitis Suppurativa—Light at the End of the Microbiological Tunnel

Langan

Recke

Bokor-Billmann

et al. 2020

IJMS

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The development of next generation sequencing, coupled with advances in bio-informatics, has provided new insights into the role of the cutaneous microbiome in the pathophysiology of a range of inflammatory skin diseases. In fact, it has even been suggested that the identification of specific skin microbial signatures may not only be useful in terms of diagnosis of skin diseases but they may also ultimately help inform personalised treatment strategies. To date, research investigating the role of microbiota in the development of inflammatory skin diseases has largely focused on atopic eczema and psoriasis vulgaris. The role of the microbiome in Hidradenits suppurativa (HS)-also known as acne inversa-a chronic auto-inflammatory skin disease associated with significant morbidity, has received comparatively little attention. This is despite the fact that antimicrobial therapy plays a central role in the treatment of HS. After briefly outlining the clinical features of HS and current treatment strategies, we move on to review the evidence of microbial dysbiosis in HS pathophysiology. We conclude by outlining the potential for metagenomic studies to deepen our understanding of HS biology but more importantly to identify novel and much needed treatment strategies.scoring and the HS severity index. Whilst the precise incidence and prevalence of HS is unclear [8], due partly to the diagnostic difficulty associated with HS and the use of both registry data and self-report questionnaires [9]. Garg et al. reported a prevalence of 0.1% in a US-based population analysis, leading the authors to conclude that HS is an uncommon but not rare disease, with over-representation in young, female and African American patients [10]. The current multi-modal treatment approach includes the use of intralesional steroids, surgical and laser therapy, topical and systemic medical antimicrobial therapy and biologic treatments [11].Sartorius scoring and the HS severity index. Whilst the precise incidence and prevalence of HS is unclear [8], due partly to the diagnostic difficulty associated with HS and the use of both registry data and self-report questionnaires [9]. Garg et al. reported a prevalence of 0.1% in a US-based population analysis, leading the authors to conclude that HS is an uncommon but not rare disease, with over-representation in young, female and African American patients [10]. The current multi-modal treatment approach includes the use of intralesional steroids, surgical and laser therapy, topical and systemic medical antimicrobial therapy and biologic treatments [11].

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“…Infliximab (IFX) is a monoclonal antibody directed against TNF-α that inhibits its downstream effects [ 112 ]. A clinical trial on IFX dosed at 5 mg/kg at weeks 0, 2, and 6 followed by maintenance dosing every 8 weeks for 22 weeks, showed a decrease of HSSI >50% (HS-specific severity index) from baseline in 26.7% of patients [ 113 , 114 ]. Although a quite low number of patients met the primary endpoint, IFX undoubtedly presented an advantage over placebo in which the majority of patients (88.9%) showed less than 25% improvement in HSSI where severe disease is defined by an HSSI score ≥13 [ 114 , 115 ].…”

Section: Resultsmentioning

confidence: 99%

Cytokine Pathways and Investigational Target Therapies in Hidradenitis Suppurativa

Duca

Morelli

Bennardo

et al. 2020

IJMS

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Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease affecting areas with a high density of apocrine glands and characterized by subcutaneous nodules that may evolve into fistulas with pus secretion. Methods: The aim of this review is to investigate all current knowledge on cytokine regulation in the pathogenesis of HS. A systematic literature research using the words “cytokine”, “interleukin”, “pathway”, and “hidradenitis suppurativa” was performed in PubMed/Medline and Scopus/Embase databases. A search of the clinicaltrials.gov website for interventional recruiting and completed trials including the term “hidradenitis suppurativa” was also performed up to August 2020. We will discuss the pathogenetic role of various cytokines in HS and potential therapeutic targets for this debilitating disease. Results: The pathophysiology underlying this complex condition has not been clearly defined. An upregulation of various cytokines, such as tumor necrosis factor alpha (TNF-α), interleukin (IL)-1, IL-17, IL-23, and other molecules seems to be related to this inflammatory condition. Various cells, such as lymphocytes T Helper 1 and 17 and keratinocytes seem to be involved in the genesis of this condition. Conclusions: Several future studies and clinical trials are necessary in order to have new knowledge about HS and to properly treat this complex condition.

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High-dose, high-frequency infliximab: A novel treatment paradigm for hidradenitis suppurativa

Cited by 54 publications

References 32 publications

What causes hidradenitis suppurativa ?—15 years after

What causes hidradenitis suppurativa ?—15 years after

The Role of the Cutaneous Microbiome in Hidradenitis Suppurativa—Light at the End of the Microbiological Tunnel

Cytokine Pathways and Investigational Target Therapies in Hidradenitis Suppurativa

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