Commentary

Adalimumab for Hidradenitis Suppurativa

Author and Disclosure Information

 

References

We applaud Kimball et al1 on their report that adalimumab demonstrated clinical improvement in patients with hidradenitis suppurativa (HS) versus placebo in 2 phase 3 trials. Hidradenitis suppurativa is a chronic relapsing condition with painful subcutaneous abscesses, malodorous drainage, sinus tract formation, and scarring that typically occurs in the axillae and anogenital region. It impairs the quality of life for these patients, as evidenced by higher Dermatology Life Quality Index scores compared to psoriasis, pimples, hand rash, atopic eczema, or control.2

The exact pathogenesis of HS is unknown but likely involves a complex interaction of genetic, hormonal, immunologic, and environmental factors.3 The levels of inflammatory cytokines are elevated in HS lesions, specifically IL-1β, tumor necrosis factor α, IL-10, and CXCL9, as well as monokines from IFN-γ, IL-11, and IL-17A. Additionally, the dermis of affected regions contains IL-12– and IL-23–containing macrophages along with IL-17–producing T cells.3 These findings reveal many potential therapeutic targets for the treatment of HS.

PIONEER I and PIONEER II are similarly designed 36-week phase 3 trials of 633 patients with HS who were unresponsive to oral antibiotic treatment.1 By week 12, a significantly greater proportion of patients receiving adalimumab demonstrated clinical improvement (≥50% reduction in total abscess and nodule count) compared to placebo in both trials (PIONEER I: 41.8% vs 26.0%, P=.003; PIONEER II: 58.9% vs 27.6%, P<.001). Secondary end points (inflammatory-nodule count, pain score, and disease severity) were only achieved in PIONEER II. The difference in clinical improvement between the trials is likely due to higher baseline disease severity in the HS patients in PIONEER I versus PIONEER II. No new safety risks were reported and were in accordance with prior adalimumab trials for other diseases. Notably, 10 paradoxical psoriasislike eruptions were reported.1

Adalimumab is the first and only US Food and Drug Administration–approved therapy for HS. Further understanding of the pathogenesis of HS may result in additional biologic treatments for HS. We encourage the manufacturers of other biologic therapies, such as infliximab,4 ustekinumab,5 anakinra,6 secukinumab, ixekizumab, and brodalumab, to consider conducting further clinical trials in HS to enhance the therapeutic options available for this debilitating disease.

Recommended Reading

High allele level linked to lamotrigine-induced SCAR
MDedge Dermatology
Granulomatous Cheilitis Mimicking Angioedema
MDedge Dermatology
Treatment challenges for lichen planopilaris
MDedge Dermatology
Hydralazine-Associated Cutaneous Vasculitis Presenting With Aerodigestive Tract Involvement
MDedge Dermatology
Study confirms new mutation, possible therapeutic target in epidermolysis bullosa
MDedge Dermatology
Management of Poorly Controlled Indolent Systemic Mastocytosis Using Narrowband UVB Phototherapy
MDedge Dermatology
Muckle-Wells Syndrome in the Setting of Basal Cell Nevus Syndrome
MDedge Dermatology
Supportive care alone linked to worse outcomes in mucocutaneous reactions
MDedge Dermatology
Many aspects to caring for epidermolysis bullosa patients
MDedge Dermatology
Bone marrow transplantation for epidermolysis bullosa continues to evolve
MDedge Dermatology

Related Articles