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    TNF Inhibitors Prove Effective

    Hidradenitis Suppurativa Systemic Therapy Options


    The results from Period A were very positive, with those patients who received adalimumab 40mg weekly showing significant improvement in their HS related abscesses and inflammatory nodules compared to those in the placebo arm at week 12 (41.8% vs 26%, respectively). Less than 5% of all patients experienced adverse events in this study: the most common were exacerbation of HS (9.2% vs 13.2%), nasopharyngitis (5.9% vs 10.5%), and headache (9.2% vs 9.9%).

    “One of the central goals of HS therapy is to reduce the inflammatory response. The nice thing about the implementation of systemic therapies like adalimumab is that we can treat the disease on a whole and not just the symptoms. TNF inhibitors can effectively address the inflammatory component and can potentially maintain a long-term improvement and relief in patients’ HS related symptoms,” said Neal Bhatia, M.D., Director of Clinical Dermatology, Therapeutics Clinical Research in San Diego, Calif.

    For milder cases of HS, Dr. Strober said that patients can be treated successfully with topical agents such as clindamycin and benzoyl peroxide. For moderate cases, the addition of oral antibiotics of the tetracycline class (doxycycline or minocycline) would be the next therapeutic step Dr. Strober said, or even the use of oral clindamycin in combination with rifampin.

    “In truth however, there are very few good therapies for moderate to severe HS until we talk about the TNF inhibitors. Adalimumab and infliximab are two drugs that have shown a very good efficacy in moderate to severe HS and in my opinion, TNF inhibition will be the gold standard therapy for HS, particularly in more severe and refractory cases,” Dr. Strober said.

    According to Dr. Strober, both adalimumab and infliximab have been shown to work well in over half the patients who take it and can benefit from those drugs. In addition to TNF inhibition, Dr. Strober recommends that patients concomitantly take methotrexate because it augments response by raising drug levels and reduces immunogenicity of the biologic.

    “I think physicians should not shy away from more aggressive therapy in HS patients because their quality of life without treatment is miserable. These patients are suffering and this is not a condition where we want to be timid and hold back because of the concern of side effects such as nasopharyngitis or headaches, which in the big picture are truly minimal compared to the devastating consequences of HS disease when not treated effectively,” Dr. Bhatia said.

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