Long-term treatment with apremilast in hidradenitis suppurativa: A 2-year follow-up of initial responders

Abstract

I 2 ¼ 69.16%; P ¼ .001) compared to nail 2 (ER, 5%; 95% CI, 3-8; I 2 ¼ 65.22%; P ¼ .002), nail 3 (ER, 5%; 95% CI, 3-8; I 2 ¼ 0.00%; P ¼ .83), nail 4 (ER, 5%; 95% CI, 3-8; I 2 ¼ 0.00%; P ¼ .74), and nail 5 (ER, 7%; 95% CI, 3-17; I 2 ¼ 73.02%; P ¼ .001) (Supplemental Fig 4; available via Mendeley at https://doi.org/10.17632/ y6kxmmz9x9.1). Regarding melanomas of individual toes, the distributions were as follows: hallux: ER, 40%; 95% CI, 25-57; I 2 ¼ 0.00%; P ¼ .53); second toe: ER, 17%; 95% CI, 8-33; I 2 ¼ .00%; P ¼ .83); third toe: ER, 24%; 95% CI, 13-38; I 2 ¼ 0.00%; P ¼ .91); fourth toe: ER, 16%; 95% CI, 7-33; I 2 ¼ 0.00%; P ¼ .65); and fifth toe: ER, 21%; 95% CI, 9-41; I 2 ¼ 9.39%; P ¼ .36). Egger's regression analysis showed no evidence of publication bias.Studies suggest that inflammation is a contributing factor to the development of several malignancies. 3 A 2020 meta-analysis exclusively in the Asian population found that areas of plantar pressure were associated with a higher number of melanomas. 4 Previous research suggests that the first toe, including the subungual surface, also has a greater tendency for trauma and repetitive sheer force. 5 Our systematic review and meta-analysis included study populations from all ethnic background and supports the hypothesis of repetitive mechanical stress as a risk factor for plantar melanoma carcinogenesis, with melanoma locations correlating with pressure areas of the feet. Future research exploring distributions of plantar melanoma and biomechanical stress patterns within the same patient population may provide further evidence for this hypothesis.

Target molecules for future hidradenitis suppurativa treatment

“…The mean values of further parameters including pain and itch were also moderately decreased in the apremilast group compared to baseline, while being mostly increased in the placebo group. Of note, there was a decrease in the overall therapy response over the 16 weeks of treatment; 85 nonetheless, a few study responders showed a sustained therapy response in a 1–2 years follow‐up study 86 . While decreasing the cutaneous pro‐inflammatory cytokine production is a clearly reasonable approach for HS, the parallel inducing effect of PDE4 inhibitors on IL‐10, a cytokine which per se is highly abundant in HS skin, should be viewed critically 18,87 .…”

Clinical Implementation of Biologics and Small Molecules in the Treatment of Hidradenitis Suppurativa

“…For the abscess and nodule count, a significant difference was observed with a mean difference of −2.6 ( p = 0.011). Patients who achieved HiSCR at the end of the study were offered to continue apremilast treatment in a compassionate use program [ 36 ]. Of the eight patients who achieved HiSCR, four discontinued before the first year.…”

Insights into the Pathogenesis of HS and Therapeutical Approaches

“…In their randomized controlled trial, including 20 patients with moderate HS (of which 15 were randomly assigned to apremilast therapy at a dose of 30 mg twice daily and 5 to placebo), Vossen and colleagues reported that, at week 16, 53% (8 out of 15) of patients achieved HiSCR in the apremilast group compared to 0% in the placebo group [ 260 ]. In a 2-year follow-up of initial responders (8 patients), HiSCR at both the 1-year and the 2-year follow-up visits (compared with baseline) was achieved by all 4 patients who continued apremilast treatment [ 261 ]. Weber et al assessed the efficacy of apremilast (30 mg twice a day) in the management of 9 patients (3 females and 6 males) with moderate-to-severe HS (5 of which had previously failed anti-TNF-α therapies).…”