Systemic therapy with immunosuppressive agents and retinoids in hidradenitis suppurativa: a systematic review

Abstract

Hidradenitis suppurativa (HS) is a difficult disease to treat. Although the pathogenesis of this inflammatory skin disease is largely unknown, the important role of the immune system has been demonstrated in both experimental and clinical studies. Clinicians are therefore increasingly prescribing systemic treatments with immunosuppressive agents, but the more traditionally used systemic retinoids, especially isotretinoin, also remain relatively common therapies. In order to provide an overview of all currently available systemic immunosuppressive agents and retinoids for the treatment of HS, a systematic search was performed using the Medline and Embase databases. All published papers concerning systemic retinoids or immunosuppressive treatments for HS in adults were included. The primary endpoints were the percentages of significant responders, moderate responders and nonresponders. Other endpoints were the relapse rate and adverse events. In total 87 papers were included, comprising 518 patients with HS who were treated with systemic retinoids, biological agents or another immunosuppressive agents, including colchicine, ciclosporin, dapsone or methotrexate. The highest response rates were observed with infliximab, adalimumab and acitretin. Overall, the quality of evidence was low and differed between the agents, making direct comparisons difficult. However, based on the amount of evidence, infliximab and adalimumab were the most effective agents. Acitretin was also effective in HS, although the quality of the evidence was low. The therapeutic effect of isotretinoin is questionable. Randomized controlled trials are needed to confirm the effectiveness of acitretin, and to identify the most effective immunosuppressive agents in HS.

Adalimumab for Treating Moderate-to-Severe Hidradenitis Suppurativa: An Evidence Review Group Perspective of a NICE Single Technology Appraisal

“…Alongside lifestyle changes (smoking cessation and weight loss), therapeutic options include topical antiseptics and antibiotics, systemic antibiotics (e.g. oral tetracyclines, clindamycin and rifampicin), anti-androgens, systemic retinoids, immunomodulatory agents, laser treatment, surgery and tumour necrosis factor-alpha (TNF-) inhibitors [11][12][13]. Treatment choices typically depend on the frequency, severity and spread of lesions and also gender in the case of the retinoid acitretin.…”

Update on Hidradenitis Suppurativa (Part I): Epidemiology, Pathogenesis, Severity assessment and Comorbidities

“…A systematic review of 147 patients treated with infliximab (mostly 5 mg/kg at weeks 0, 2 and 6) found a significant improvement in 50% of patients and 39% more showed moderate improvement. 98 The majority of patients received maintenance therapy every 6-8 weeks .98 Etanercept is considered inefficacious for HS. 1,23 Ustekinumab, an anti-IL-12/IL-23 antibody, has also been used (45 or 90 mg at weeks 0, 4, 16 and 28) with good results.…”

Hidradenitis suppurativa: why isn’t it a form of acne?

“…Blok és munkatársai szisztematikus összefoglalójában hat klinikai vizsgálat eredményeit értékelték. Összesen 22 beteg kapott acitretin vagy etretinát kezelést 2-29 hónapon keresztül, jelentős javulást 16 esetben, közepes javulást 5 betegnél észleltek (38). Relapszus ezen betegnél 6 esetben hat hónapon belül, míg 8 esetben több mint egy év eltelté-vel jelentkezett.…”

“…Relapszus ezen betegnél 6 esetben hat hónapon belül, míg 8 esetben több mint egy év eltelté-vel jelentkezett. Isotretinoinnal kapcsolatosan ezen szisztematikus összefoglalóban hét vizsgálat szerepel, melyek során összesen 174 beteget kezeltek 0,5-1,2 mg/kg/nap dózisban 4-12 hónapig (38) (39)(40)(41)(42). A rendelkezésre álló evidenciák alapján az adalimumab és az infliximab hatásos kezelések a betegségben, javítják a betegek életminőségét.…”