Long-term Successful Adalimumab Therapy in Severe Hidradenitis Suppurativa

Abstract

Background: Several studies report the use of tumor necrosis factor ␣ (TNF-␣) inhibitors in refractory hidradenitis suppurativa (HS), particularly infliximab and etanercept. However, very limited data have been reported for adalimumab, the newest fully human anti-TNF-␣ monoclonal antibody. We evaluated the long-term efficacy and safety of adalimumab therapy in 6 patients with refractory HS. In the case of positive culture findings from any draining lesion, antibiotic therapy was administered for at least 2 weeks before initiating adalimumab therapy. Adalimumab (in 40-mg subcutaneous injections) was prescribed every other week. If the disease was inadequately controlled, the dosage was increased to 40 mg/wk. If HS was in persistent clinical remission, adalimumab therapy was gradually decreased to 40 mg every 3 weeks. Quality of life was assessed using the Dermatology Life Quality Index. Observations: Six patients (mean [SD] age, 39.3 [12.9] years) with severe HS (mean [SD] duration, 22.5 [11.7] years) were treated with adalimumab. Significant improvements after 1 month of treatment were seen in the Dermatology Life Quality Index; in the number of affected regions, nodules, and fistulas; and in the basic laboratory findings. Improvements were maintained for a mean (SD) follow-up of 21.5 (7.1) (range, 13-29) months. Adalimumab was well tolerated. Conclusion: Adalimumab appears to be an effective and safe treatment for refractory HS.

Clinicopathological Study of 13 Cases of Squamous Cell Carcinoma Complicating Hidradenitis Suppurativa

“…This has to be underlined because infliximab, etanercept and adalimumab appear to be new approaches in severe extensive forms of HS [55,56,57,58]. So, in HS, as Comte et al [59 ]described in psoriasis, we recommend to check for HPV lesions before considering anti-TNF-α treatment.…”

An Update on Medical Treatment Options for Hidradenitis Suppurativa

“…Overall, anti-TNF-a biologics are well tolerated, and patients can be treated for prolonged periods [12,64,65].…”

“…It has been suggested that a weekly dose is more effective [3]. In a retrospective study Blanco et al [64] initially started with 40 mg every other week, but in five of the six patients the dose had to be increased to 40 mg every week to prevent relapse. In a large prospective randomized placebo-controlled trial, 40 mg adalimumab weekly was more effective than 40 mg every other week or placebo after 16 weeks of treatment [12].…”

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

“…Regarding adalimumab, in both case reports and more extensive studies, an improvement in HS lesions was observed between 4 and 12 weeks of treatment, and the results were maintained for the duration of therapy, despite increasing doses specified in some reports [7,8,9,10,11,12,13,14,15,16,17,18] (data summarized in table 3). Therefore, adalimumab treatment seems to have a favorable outcome in the treatment of HS, with improvement somewhat slower than with infliximab, but maintained over time, with a high safety profile.…”

“…Therefore, adalimumab treatment seems to have a favorable outcome in the treatment of HS, with improvement somewhat slower than with infliximab, but maintained over time, with a high safety profile. The main secondary adverse event was edema at the site of injection; other serious adverse effects were exceptional [7,8,9,10,11,12,13,14,15,16,17,18,19,20,21]. Miller et al [20] conducted a double-blind placebo-controlled study which included 15 patients who received adalimumab 80 mg at week 1 and 40 mg eow for 12 weeks; 6 remaining patients were given a placebo.…”