Successful treatment of recalcitrant hidradenitis suppurativa with risankizumab after failure of anti‐tumour necrosis factor alpha

Abstract

DEAR EDITOR, Hidradenitis suppurativa (HS) is a relapsing inflammatory skin disease. The cytokines interleukin (IL)-1b, IL-12, IL-23, IL-17 and tumour necrosis factor (TNF)-a are involved in the inflammatory process. 1 The only approved drug for the treatment of moderate-to-severe cases is adalimumab (a TNF-a inhibitor). However, long-term clinical responses range only from 52 to 57%. 2 Tildrakizumab (anti-IL-23), 3 guselkumab (anti-IL-23) 4 and ustekinumab (anti-IL-12/23) 5 have been successfully used in HS.Risankizumab is a humanized IgG1 monoclonal antibody selective to IL-23. It is currently approved for the treatment of moderate-to-severe plaque psoriasis in adults. 6 We describe two patients with severe Hurley Stage III HS, successfully treated with risankizumab:Patient 1 was a 39-year-old woman, a nonsmoker with a body mass index (BMI, kg m -2 ) of 28Á9. Her medical history included depression and multiple sclerosis (MS). Her mother and grandfather have been treated for HS. Historically, she was treated with systemic azithromycin, doxycycline, clindamycin, rifampicin, isotretinoin and, lastly, adalimumab (40 mg per week subcutaneously). Three months after starting adalimumab, she achieved a Hidradenitis Suppurativa Clinical Response (HiSCR). Loss of response (LoR) was observed after 20 months and consequently adalimumab was discontinued

Risankizumab effectiveness in a recalcitrant case of hidradenitis suppurativa after anti‐TNF and anti‐interleukin‐17 failures

“…In our experience, and in according to the results reported by Marques et al, 8 risankizumab may reach a rapid decline in disease severity and a substantial improvement of treated subjects' life quality. Also in the mentioned above study, none of the patients included reported any adverse effects.…”

New perspectives on the treatment of hidradenitis suppurativa

“…Three publications report clinical response to risankizumab in four patients treated at psoriasis doses (150 mg sc at week 0, week 4, and every 12 weeks thereafter). [184][185][186] A phase II, double-blind RCT to evaluate the safety and efficacy of two dose levels of risankizumab in adult patients with moderate-to-severe HS is being conducted (NCT03926169). 187 Tildrakizumab is a humanized monoclonal antibody that targets the p19 subunit of IL-23.…”

Present and future trends of biologic therapies and small molecules in hidradenitis suppurativa

“…So far, only retrospective data on the efficacy of risankizumab within small groups of patients with HS have been reported with acceptable results 58 .…”