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    Therapies for hidradenitis suppurativa

    Biologics added to the list of potential options for treating this challenging disease

    Robert Micheletti, M.D.Dr. MichelettiAlthough hidradenitis suppurativa is a disease that is extremely impactful and burdensome several medical therapies have been proven to be effective and safe.

    “People go on average 7 years without a diagnosis,” says Robert Micheletti, M.D., an assistant professor of dermatology and medicine at the University of Pennsylvania in Philadelphia. “Hidradenitis suppurativa (HS) is also probably the worst systematically studied disease in dermatology with respect to quality of life.”

    Symptoms of depression and anxiety as well as several important medical comorbidities are also part of the mix, including increased cardiovascular risk.

    Dr. Micheletti, who spoke with Dermatology Times in advance of his presentation on the latest in HS at the 2017 American Academy of Dermatology (AAD) annual meeting in March in Orlando, Fla., says historically HS has been a challenging disease for both patients and providers.

    “Treatment can be frustrating, with less than desirable results,” Dr. Micheletti says. “But now there is a message of hope, thanks to agents with reasonable data to justify treating very severe HS.”

    Adalimumab FDA approved

    The most recent notable development is FDA approval, in September 2015, of the biologic adalimumab (Humira, Abbott Laboratories), which is a tumor necrosis factor (TNF) inhibitor.

    “This is the first medication FDA approved for HS,” Dr. Micheletti states. “We now have an expensive biologic medicine that you can actually prescribe to your patients because it is FDA approved.”

    The dosing for adalimumab is also significantly greater than for psoriasis.

    “The dosing is similar to Crohn’s disease,” Dr. Micheletti says.

    The dosing protocol for the self-administered subcutaneous injection begins at 160 mg at week 0, then 80 mg at week 2, followed by 40 mg weekly starting at week 4, which is ongoing.

    “The loading dose appears to help induce a response,” Dr. Micheletti says.

    The FDA studies for adalimumab found a clinically relevant response in about 50% of patients, compared to roughly 25% of placebo patients.

    Infliximab, not only for psoriasis

    A second TNF inhibitor for HS is infliximab (Remicade, Janssen), also used to treat psoriasis. The investigational drug involves an intravenous infusion, usually 5 mg/kg every 8 weeks, but sometimes higher, lasting a few hours, at either an infusion center or an outpatient hospital setting.

    “The largest published study of infliximab showed a greater than 25% improvement in 87% of patients versus only 11% in the placebo group,” Dr. Micheletti reports.

    “Anecdotally, we see patients with moderate or severe disease respond to one of these two medications, so both of these medications are reasonable options,” he says. “If one does not work, you can try the other and vice versa.”

    Next: Other biologic options

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