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Eshmawi MT, Yousef Al-Mudaiheem H, Fatani M, Binamer Y, Alajlan M, Alharithy R, Alotaibi H, Almohanna HM, Alsantali A, Madani A, Al-Faraidy N, Bechara FG, Hamden Al-Jedaie A. Expert consensus on unmet needs, referral criteria and treatment goals for hidradenitis suppurativa in Saudi Arabia. J DERMATOL TREAT 2024; 35:2353693. [PMID: 38862417 DOI: 10.1080/09546634.2024.2353693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 05/01/2024] [Indexed: 06/13/2024]
Abstract
Purpose: There is limited information about the diagnosis and treatment of hidradenitis suppurativa (HS) in the Kingdom of Saudi Arabia (KSA). This Delphi consensus study was conducted to develop recommendations for the management of HS in the KSA.Methods: The expert panel including 12 dermatologists with extensive experience treating HS patients provided nine consensus statements and recommendations on diagnosis and assessment, management, comorbidities and multidisciplinary approach, and education. The experts also developed clinical questions pertaining to the management of HS and rolled out as a survey to 119 dermatologists practising in the KSA.Results: The topics covered included: referring physicians' awareness of HS; referral criteria for HS; definition of moderate-to-severe HS; treatment goals; definition of treatment success; treatment and biologic initiation; comorbidities and multidisciplinary approach; patient education and awareness of HS. Full consensus (100%) from the expert dermatologists was received on all the topics except referring physicians' awareness of HS, definition of treatment success, and treatment and biologic initiation. The survey results resonated with the expert opinion.Conclusion: As HS is a chronic disease with negative impact on quality-of-life, timely diagnosis and treatment, early identification of comorbid conditions and a multidisciplinary care approach are crucial for effective management of HS.
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Affiliation(s)
- Maysa T Eshmawi
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
- King Abdullah Medical Complex Jeddah, MOH, Saudi Arabia
| | | | - Mohammed Fatani
- Department of Dermatology, Hera General Hospital, Makkah, Saudi Arabia
| | - Yousef Binamer
- Department of Dermatology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- Alfaisal University, Riyadh, Saudi Arabia
| | - Mohammed Alajlan
- Department of Dermatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ru'aa Alharithy
- Department of Dermatology, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Hend Alotaibi
- Department of Dermatology, King Saud University, Riyadh, Saudi Arabia
| | - Hind M Almohanna
- Department of Dermatology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Adel Alsantali
- Department of Dermatology, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Abdulaziz Madani
- Department of Dermatology, College of medicine, King Saud University, Riyadh, Saudi Arabia
| | - Nadya Al-Faraidy
- Department of Medicine, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Falk G Bechara
- Department of Dermatology, Venereology and Allergology, Ruhr-University, Bochum, Germany
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Barzilai A, Toubiana S, Dalal A, Baum S. The role of piperacillin/tazobactam in the treatment of Hidradenitis suppurativa. J DERMATOL TREAT 2024; 35:2363318. [PMID: 39103159 DOI: 10.1080/09546634.2024.2363318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 05/27/2024] [Indexed: 08/07/2024]
Abstract
Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease. Most patients with moderate-to-severe disease require long-term antibiotic treatment, or biologic treatments to control their disease. Despite these interventions, relapses are common. This study evaluated the effectiveness of piperacillin/tazobactam treatment in patients with Hurley stage II and III HS who experienced disease flares and did not respond to conventional antibiotic and biologic treatment. Methods: Patients with HS hospitalized at the Department of Dermatology, Sheba Medical Center between August 2021 and January 2023 were retrospectively analyzed. Results: A cohort of ten such patients were treated with piperacillin/tazobactam for 6-21 days. Eight (80%) and two (20%) patients respectively demonstrated 2- and 1-grade improvements, from their baseline HS-Physician Global Assessment score. During the follow-up period, nine patients were monitored. HS Clinical Response (HiSCR) was achieved in six (66.7%) and five (55.6%) patients at the 3- and 6-month follow-up visits, respectively. Conclusions: In conclusion, Piperacillin/tazobactam emerges as a promising therapeutic option for disease flare-up in patients with Hurley stage II and III HS who do not respond to conventional treatment. Thus, piperacillin/tazobactam should be considered as crisis therapy for this patient subset.
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Affiliation(s)
- Aviv Barzilai
- Department of Dermatology, Sheba Medical Center, Tel-HaShomer, Ramat-Gan, Tel Aviv University, Tel Aviv, Israel
- Institute of Pathology, Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shir Toubiana
- Department of Dermatology, Sheba Medical Center, Tel-HaShomer, Ramat-Gan, Tel Aviv University, Tel Aviv, Israel
| | - Adam Dalal
- Department of Dermatology, Sheba Medical Center, Tel-HaShomer, Ramat-Gan, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Baum
- Department of Dermatology, Sheba Medical Center, Tel-HaShomer, Ramat-Gan, Tel Aviv University, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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3
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Gunter SJ, Porter ML, Kimball AB. Placebo responders with moderate-to-severe hidradenitis suppurativa experience declines in inflammation as measured by C-reactive protein: a post hoc analysis of two double-blinded, randomized-controlled trials. Int J Womens Dermatol 2024; 10:e171. [PMID: 39170879 PMCID: PMC11338249 DOI: 10.1097/jw9.0000000000000171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 07/09/2024] [Indexed: 08/23/2024] Open
Affiliation(s)
| | - Martina L. Porter
- Clinical Laboratory for Epidemiology and Applied Research in Skin (CLEARS), Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - Alexa B. Kimball
- Clinical Laboratory for Epidemiology and Applied Research in Skin (CLEARS), Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts
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Pandey A. Essentials of hidradenitis suppurativa: a comprehensive review of diagnostic and treatment perspectives. Ann Med Surg (Lond) 2024; 86:5304-5313. [PMID: 39239023 PMCID: PMC11374290 DOI: 10.1097/ms9.0000000000002345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 06/24/2024] [Indexed: 09/07/2024] Open
Abstract
Hidradenitis suppurativa, or acne inversa, is a chronic inflammatory skin condition with recurrent inflammatory nodules, abscesses, subcutaneous tracts, and scars. This condition may cause severe psychological distress and reduce the quality of life for affected individuals. It is considered to have one of the most damaging effects on quality of life of any skin disorder as a result of the discomfort and foul-smelling discharge from these lesions. Although the pathophysiology of HS is still unclear, multiple factors, including lifestyle, genetic, and hormonal factors, have been associated with it. The pathogenesis of HS is very complex and has wide clinical manifestations; thus, it is quite challenging to manage and often requires the use of combination treatments that must be tailored according to disease severity and other patient-specific factors. Although lifestyle changes, weight loss, quitting smoking, topical treatments, and oral antibiotics are adequate for mild cases, the challenge for healthcare professionals is dealing with moderate-to-severe HS, which often does not respond well to traditional approaches. This literature review, consisting of an overview of the various assessment tools and therapy strategies available for the diagnosis and treatment of HS from published literature, aims to be a guide for practicing clinicians in dealing with the complexities associated with this disease.
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Affiliation(s)
- Archana Pandey
- Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, Nepal
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5
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Offidani A, Marzano AV, Peris K, Molinelli E, Bettoli V, Magnoni C, Vaienti L, Pappagallo G, Amerio P, Atzori L, Balato A, Bianchi L, Bongiorno MR, Contedini F, Dapavo P, Di Benedetto G, Dini V, Donini M, Fabbrocini G, Fania L, Foti C, Gatti A, Guarneri C, Malara G, Manfredini M, Morrone P, Naldi L, Parodi A, Potenza C, Schianchi S, Stingeni L, Trovato E, Vaira F, Valenti M, Venturini M, Chiricozzi A, Prignano F. Guidelines How to Integrate Surgery and Targeted Therapy with Biologics for the Treatment of Hidradenitis Suppurativa: Delphi Consensus Statements from an Italian Expert Panel. Dermatology 2024:1-12. [PMID: 39004081 DOI: 10.1159/000539264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 04/14/2024] [Indexed: 07/16/2024] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by recurrent and painful nodules and abscesses in intertriginous skin areas, which can progress to sinus tract formation, tissue destruction, and scarring. HS is highly debilitating and severely impairs the psychological well-being and quality of life of patients. The therapeutic approach to HS is based on medical therapy and surgery. First-line medical therapy includes topical antibiotics, systemic antibiotics, and biologics. Main surgical procedures include deroofing, local excision, and wide local excision. Despite the availability of multiple therapeutic options, the rates of disease recurrence and progression continue to be high. In recent years, the possibility of combining biologic therapy and surgery has raised considerable interest. In a clinical trial, the perioperative use of adalimumab has been associated with greater response rates and improved inflammatory load and pain, with no increased risk of postoperative infectious complications. However, several practical aspects of combined biologic therapy and surgery are poorly defined. In June 2022, nine Italian HS experts convened to address issues related to the integration of biologic therapy and surgery in clinical practice. To this purpose, the experts identified 10 areas of interest based on published evidence and personal experience: (1) patient profiling (diagnostic criteria, disease severity classification, assessment of response to treatment, patient-reported outcomes, comorbidities); (2) tailoring surgery to HS characteristics; (3) wide local excision; (4) presurgery biologic treatment; (5) concomitant biologic and surgical treatments; (6) pre- and postsurgery management; (7) antibiotic systemic therapy; (8) biologic therapy after radical surgery; (9) management of adverse events to biologics; and (10) management of postoperative infectious complications. Consensus between experts was reached using the Estimate-Talk-Estimate method (Delphi Method). The statements were subsequently presented to a panel of 27 HS experts from across Italy, and their agreement was assessed using the UCLA Appropriateness Method. This article presents and discusses the consensus statements.
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Affiliation(s)
- Annamaria Offidani
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Milan, Italy
| | - Ketty Peris
- UOC of Dermatology, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
- Dermatology, Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elisa Molinelli
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Vincenzo Bettoli
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Cristina Magnoni
- Department of Dermatology, Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Luca Vaienti
- Department of Reconstructive and Aesthetic Plastic Surgery, University of Milan, I.R.C.C.S. Istituto Ortopedico Galeazzi, Milan, Italy
| | - Giovanni Pappagallo
- School of Clinical Research Methodology, IRCCS "Sacro Cuore - Don Calabria Hospital", Negrar di Valpolicella, Italy
| | - Paolo Amerio
- Dermatologic Clinic, G. D'Annunzio University, Chieti, Italy
| | - Laura Atzori
- Unit of Dermatology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Anna Balato
- Dermatology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Luca Bianchi
- UOSD of Dermatology, Policlinico Tor Vergata, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Maria Rita Bongiorno
- Department of Health Promotion Sciences, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Federico Contedini
- Department of Plastic Surgery, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Paolo Dapavo
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Giovanni Di Benedetto
- Clinic of Plastic and Reconstructive Surgery, Department of Experimental and Clinical Medicine, Marche Polytechnic University Medical School, Ancona, Italy
| | - Valentina Dini
- Department of Dermatology, University of Pisa, Pisa, Italy
| | - Massimo Donini
- Department of Dermatology, SS Giovanni e Paolo Civil Hospital, Venice, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Luca Fania
- Dermatology Unit, IDI-IRCCS, Rome, Italy
| | - Caterina Foti
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Dermatology, University of Bari Aldo Moro, Bari, Italy
| | - Alessandro Gatti
- Department of Dermatology, AULSS2 Marca Trevigiana, Hospital Ca' Foncello, Treviso, Italy
| | - Claudio Guarneri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Giovanna Malara
- Dermatology Unit, Hospital "Bianchi Melacrino Morelli", Reggio Calabria, Italy
- Department of Dermatology, Papardo Hospital, Messina, Italy
| | - Marco Manfredini
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Pietro Morrone
- Unit of Dermatology, Mariano Santo Hospital, Cosenza, Italy
| | - Luigi Naldi
- Division of Dermatology, San Bortolo Hospital, Vicenza, Italy
| | - Aurora Parodi
- Unit of Dermatology, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | | | | | - Luca Stingeni
- Dermatology Section, Medical and Surgical Department, University of Perugia, Perugia, Italy
| | - Emanuele Trovato
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Fabrizio Vaira
- Unit of Dermatology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Mario Valenti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Dermatology Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Marina Venturini
- Section of Dermatology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Andrea Chiricozzi
- UOC of Dermatology, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
- Dermatology, Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesca Prignano
- Department of Health Science, Section of Dermatology, University of Firenze, Firenze, Italy
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Shipman WD, Williams MN, Suozzi KC, Eisenstein AS, Dover JS. Efficacy of laser hair removal in hidradenitis suppurativa: A systematic review and meta-analysis. Lasers Surg Med 2024; 56:425-436. [PMID: 38769894 DOI: 10.1002/lsm.23796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/17/2024] [Accepted: 04/22/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVES Hidradenitis suppurativa (HS) is a chronic inflammatory condition characterized by painful nodules, draining tunnels, and fibrotic scarring in intertriginous, hair-bearing areas. The pathogenesis involves follicular occlusion and subsequent rupture, leading to uncontrolled inflammation. Treatment options for HS are limited and lack universal effectiveness. Laser hair removal (LHR) has been explored as a potential treatment; however, the efficacy and appropriate laser modalities remain unclear. This systematic review examined the efficacy and adverse effects of LHR in HS. METHODS A comprehensive literature search was conducted from inception to September 2023 in Ovid MEDLINE, Ovid Embase, and The Cochrane Library (Wiley) with predefined inclusion and exclusion criteria, and a meta-analysis was conducted. RESULTS Ten studies were selected (n = 227 total patients) and included six randomized controlled trials, two nonrandomized experimental studies, and two case series. Various laser modalities, including long-pulsed neodymium-doped yttrium aluminum garnet (Nd:YAG) (n = 115), intense pulsed light (n = 18), Alexandrite (n = 54), intralesional 1064 nm diode (n = 20), and combined fractional CO2 and long-pulsed Nd:YAG laser (n = 20), consistently demonstrated significant improvement in HS disease severity, irrespective of the disease scoring method used. Minimal adverse effects (primarily mild pain and erythema) were reported. A meta-analysis of three studies utilizing long-pulsed Nd:YAG laser demonstrated a standardized mean difference in disease severity of -1.68 (95% confidence interval: -2.99; -0.37), favoring treatment with LHR for HS. CONCLUSIONS Hair follicles are key in HS pathogenesis and all included studies showed a significant improvement in HS disease severity after LHR regardless of the laser device used, likely related to hair follicle unit destruction. HS is a complex and heterogenous condition, and multiple disease scoring methods complicate outcome comparisons across studies. However, LHR, utilizing various techniques, is an effective treatment option for HS with minimal adverse effects.
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Affiliation(s)
- William D Shipman
- Department of Dermatology, Yale University, New Haven, Connecticut, USA
| | - Monica N Williams
- Department of Dermatology, Medstar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Kathleen C Suozzi
- Department of Dermatology, Yale University, New Haven, Connecticut, USA
| | - Anna S Eisenstein
- Department of Dermatology, Yale University, New Haven, Connecticut, USA
| | - Jeffrey S Dover
- Department of Dermatology, Yale University, New Haven, Connecticut, USA
- SkinCare Physicians, Chestnut Hill, Massachusetts, USA
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Aarts P, van Huijstee JC, van der Zee HH, van Straalen KR, Prens EP. Improved clinical effectiveness of adalimumab when initiated with clindamycin and rifampicin in hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2024; 38:904-909. [PMID: 38112226 DOI: 10.1111/jdv.19725] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/09/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Adalimumab monotherapy for hidradenitis suppurativa (HS) is often insufficient with a maximum clinical efficacy of 60% in Hidradenitis Suppurativa Clinical Response (HiSCR) and limited effect on draining tunnels. Data suggest that adalimumab therapy could be improved by concomitant antibiotics. OBJECTIVE To compare the clinical effectiveness of adalimumab with clindamycin and rifampicin versus adalimumab monotherapy after 12 weeks. METHODS This retrospective study included patients who started adalimumab with additional clindamycin and rifampicin and patients treated with adalimumab monotherapy, matched on sex and refined Hurley score. The primary outcome measure was the difference in change in the International Hidradenitis Suppurativa Severity Score System (IHS4) at 12 weeks. RESULTS In total, 62 patients were included in the combination therapy group (n = 31) and adalimumab monotherapy group (n = 31), showing comparable IHS4 scores; 32.5 versus 29, p = 0.87 at baseline respectively. The combination therapy demonstrated greater clinical effectiveness expressed in median IHS4 improvement (-20 vs. -9, p < 0.001), IHS4-55 (74% vs. 36%, p = 0.002), median draining tunnel reduction (-4 vs. -2, p < 0.001) and pain response (47% vs. 27%, p = 0.02). CONCLUSION Adalimumab initiated with clindamycin and rifampicin shows greater clinical effectiveness than adalimumab monotherapy. An important difference in effect was observed in the decrease of draining tunnels, addressing a serious limitation of adalimumab monotherapy.
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Affiliation(s)
- P Aarts
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J C van Huijstee
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - H H van der Zee
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - K R van Straalen
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - E P Prens
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Greenlund L, Herzog C, Wendland Z, Rypka K, Frew JW, Kirby JS, Alavi A, Khalid B, Lowes MA, Garg A, Marzano AV, Zouboulis CC, Tzellos T, Jaleel T, Goldfarb N. Discrepancies in hidradenitis suppurativa lesion characterization by providers and patients. J Eur Acad Dermatol Venereol 2024. [PMID: 38595320 DOI: 10.1111/jdv.19999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/28/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND The hidradenitis suppurativa (HS) clinical response (HiSCR) has come under scrutiny as several HS clinical trials failed to meet primary endpoints with high placebo responses. This may be due to limitations of the tool and raters' ability to accurately characterize and count lesions, rather than lack of efficacy of the studied drug. Due to HS lesion complexity and potential differences in rater training, it was hypothesized that there would be discrepancies in how providers characterize and count lesions for HS clinical trials. OBJECTIVE To evaluate how HS providers and patients name and count HS lesions and to identify discrepancies among providers to initiate the development of consensus-driven guidance for HS rater training. METHODS An online survey was distributed to the members of HIdradenitis SuppuraTiva cORe outcomes set International Collaboration (HISTORIC). Respondents were asked to classify lesion images composed of multiple and different morphology types and answer questions regarding inclusion of associated dermatological conditions. RESULTS Forty-seven HISTORIC members responded (29 providers; 18 patients). There was variability in how respondents classified HS lesions. Of 12 questions containing images, four had ≥50% of respondents choosing the same answer. With an image of a lesion composed of different morphologies, 45% of providers counted it as a single lesion and 45% counted it as multiple distinct lesions. With an image of multiple interconnected draining tunnels, 7% of providers classified it as a single draining tunnel while 79% categorized it as multiple draining tunnels with the number estimated by visual inspection. There was also variability in deciding whether lesions occurring in associated conditions should be considered separately or included in HS lesion counts. Patient responses were also variable. CONCLUSIONS The result of the current study reaffirms the gap in how providers characterize and count HS lesions for clinical trials and the need to develop consensus-driven rater training related to HS outcome measures.
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Affiliation(s)
| | - Claire Herzog
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Zachary Wendland
- Department of Dermatology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Department of Dermatology, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
| | - Katelyn Rypka
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Department of Dermatology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Department of Dermatology, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
| | - John W Frew
- Laboratory of Translational Cutaneous Medicine, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Joslyn S Kirby
- Department of Dermatology, Penn State Health, Hershey, Pennsylvania, USA
| | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Bisma Khalid
- Department of Dermatology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Michelle A Lowes
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York, USA
| | - Amit Garg
- Northwell Health, New York, New York, USA
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA
| | - Angelo V Marzano
- Dermatology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - Thrasyvoulos Tzellos
- Department of Dermatology, Nordland Hospital Trust, NLSH Bodø, Bodø, Norway
- Department of Clinical Medicine, UiT The Arctic University of Norway, TRomsø, Norway
| | - Tarannum Jaleel
- Department of Dermatology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Noah Goldfarb
- Department of Dermatology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Department of Dermatology, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
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Stergianou D, Kanni T, Damoulari C, Giamarellos-Bourboulis EJ. An evaluation of secukinumab for the treatment of moderate-to-severe hidradenitis suppurativa. Expert Opin Biol Ther 2024; 24:225-232. [PMID: 38602836 DOI: 10.1080/14712598.2024.2343112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/10/2024] [Indexed: 04/13/2024]
Abstract
INTRODUCTION Until recently, biological therapy for hidradenitis suppurativa was limited to anti-tumor necrosis factor (TNF) blockade with adalimumab (ADA). However, not all patients respond to treatment with ADA. This highlighted the need for more therapeutic options. Interleukin (IL)-17/T-helper 17 (Th17) axis may play an important role in the pathophysiology of HS. Recently, the IL-17A inhibitor secukinumab, which targets IL-17A specifically and prevents it from interacting with the IL-17 receptor, has been FDA-approved for HS. AREAS COVERED Secukinumab, represents a novel therapeutic strategy in HS management. An overview of structural and pharmacological characteristics is provided. Described efficacy in clinical trials and case reports and safety data from is presented. EXPERT OPINION As response to anti-TNFas is lost over time, secukinumab has provided an alternative HS treatment option in clinical practice. Overall, secukinumab has shown good efficacy and a favorable side effect profile in HS clinical trials but may be avoided in patients with inflammatory bowel disease. Long-term and real-life data on the use of secukinumab are essential for improving decision-making in HS therapy.
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Affiliation(s)
- Dimitra Stergianou
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Theodora Kanni
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Christina Damoulari
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
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10
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Kimball AB, Peeva E, Forman S, Moiin A, Khattri S, Porter ML, Mangold AR, Ghosh P, Banfield C, Oemar B. Brepocitinib, Zimlovisertib, and Ropsacitinib in Hidradenitis Suppurativa. NEJM EVIDENCE 2024; 3:EVIDoa2300155. [PMID: 38335032 DOI: 10.1056/evidoa2300155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
BACKGROUND: Hidradenitis suppurativa (HS) is a debilitating, inflammatory skin disease with limited treatment options and partially understood pathophysiology. Using an umbrella trial design, three kinase inhibitor immunomodulators with different mechanisms of action were evaluated. METHODS: This phase 2a, double-blind, parallel-group trial enrolled adults with moderate to severe HS who were then randomly assigned (1:1:1:1) to once-daily brepocitinib 45 mg (a JAK1/TYK2 inhibitor), zimlovisertib 400 mg (an IRAK4 inhibitor), ropsacitinib 400 mg (a TYK2 inhibitor), or matching placebo for 16 weeks. The primary end point was the percentage of participants achieving HS clinical response (HiSCR) at week 16. Safety, including treatment-emergent adverse events (TEAEs), was monitored throughout. RESULTS: Totals of 52, 47, 47, and 48 participants were assigned to brepocitinib, zimlovisertib, ropsacitinib, and placebo, respectively. At week 16, 28% were lost to follow-up and assumed to be nonresponders; HiSCR occurred in 33.3% (16/48) of participants receiving placebo and in 51.9% (27/52), 34.0% (16/47), and 37.0% (17/46) of those receiving brepocitinib, zimlovisertib, and ropsacitinib (difference in percentage points vs. placebo [90% confidence interval], 18.7 [2.7 to 34.6], 0.7 [−15.2 to 16.7], and 3.5 [−12.6 to 19.6]), respectively. TEAEs occurred more frequently with active treatment (brepocitinib, 30 [57.7%]; zimlovisertib, 26 [55.3%]; ropsacitinib, 29 [61.7%]; placebo, 23 [47.9%]). Most TEAEs (infections, skin disorders, and gastrointestinal symptoms) were mild; there were no deaths. CONCLUSIONS: Participants with moderate to severe HS treated with brepocitinib experienced greater clinical response, whereas those on zimlovisertib and ropsacitinib did not, compared with placebo. These results favor the JAK/STAT pathway as an immunologic target in HS and did not confirm a role for selective IRAK4 or TYK2 inhibition. These results should be confirmed in larger studies with longer follow-up. (Funded by Pfizer; ClinicalTrials.gov registration number, NCT04092452.)
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Affiliation(s)
- Alexa B Kimball
- Harvard Medical School and Beth Israel Deaconess Medical Center, Boston
| | | | | | - Ali Moiin
- Revival Research Institute, LLC, Southfield, MI
| | - Saakshi Khattri
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York
| | - Martina L Porter
- Harvard Medical School and Beth Israel Deaconess Medical Center, Boston
| | - Aaron R Mangold
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, AZ
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11
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Garg A, Mastacouris N, Ingram JR, Strunk A. Addressing high placebo response rates in randomized clinical trials for hidradenitis suppurativa. Br J Dermatol 2024; 190:427-429. [PMID: 37757841 DOI: 10.1093/bjd/ljad375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/31/2023] [Accepted: 10/21/2023] [Indexed: 09/29/2023]
Affiliation(s)
- Amit Garg
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Nicole Mastacouris
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - John R Ingram
- Division of Infection and Immunity, Cardiff University, University Hospital of Wales, Heath Park, Cardiff, UK
| | - Andrew Strunk
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
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12
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Ingram JR, Bates J, Cannings-John R, Collier F, Evans J, Gibbons A, Harris C, Howells L, Hood K, Howes R, Leighton P, Riaz M, Rodrigues J, Stanton H, Thomas KS, Thomas-Jones E. Treatment of Hidradenitis Suppurativa Evaluation Study (THESEUS): a prospective cohort study. Br J Dermatol 2024; 190:382-391. [PMID: 37823414 DOI: 10.1093/bjd/ljad388] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 07/21/2023] [Accepted: 10/05/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic, painful disease affecting flexures and other skin regions, producing nodules, abscesses and skin tunnels. Laser treatment targeting hair follicles and deroofing of skin tunnels are standard HS interventions in some countries but are rarely offered in the UK. OBJECTIVES To describe current UK HS management pathways and influencing factors to inform the design of future randomized controlled trials (RCTs). METHODS THESEUS was a nonrandomized 12-month prospective cohort study set in 10 UK hospitals offering five interventions: oral doxycycline 200 mg daily; oral clindamycin and rifampicin both 300 mg twice daily for 10 weeks, extended for longer in some cases; laser treatment targeting hair follicles; deroofing; and conventional surgery. The primary outcome was the combination of clinician-assessed eligibility and participant hypothetical willingness to receive each intervention. The secondary outcomes were the proportion of participants selecting each intervention as their final treatment option; the proportion who switch treatments; treatment fidelity; and attrition rates. THESEUS was prospectively registered on the ISRCTN registry: ISRCTN69985145. RESULTS The recruitment target of 150 participants was met after 18 months, in July 2021, with two pauses due to the COVID-19 pandemic. Baseline demographics reflected the HS secondary care population: average age 36 years, 81% female, 20% non-White, 64% current or ex-smokers, 86% body mass index ≥ 25, 68% with moderate disease, 19% with severe disease and 13% with mild disease. Laser was the intervention with the highest proportion (69%) of participants eligible and willing to receive treatment, then deroofing (58%), conventional surgery (54%), clindamycin and rifampicin (44%), and doxycycline (37%). Laser was ranked first choice by the greatest proportion of participants (41%). Attrition rates were 11% and 17% after 3 and 6 months, respectively. Concordance with doxycycline was 52% after 3 months due to lack of efficacy, participant choice and adverse effects. Delays with procedural interventions were common, with only 43% and 26% of participants starting laser and deroofing, respectively, after 3 months. Uptake of conventional surgery was too small to characterize the intervention. Switching treatment was uncommon and there were no serious adverse events. CONCLUSIONS THESEUS has established laser treatment and deroofing for HS in the UK and demonstrated their popularity with patients and clinicians for future RCTs.
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Affiliation(s)
| | - Janine Bates
- Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Cardiff, UK
| | - Rebecca Cannings-John
- Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Cardiff, UK
| | | | - Judith Evans
- Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Cardiff, UK
| | | | | | - Laura Howells
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Kerenza Hood
- Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Cardiff, UK
| | - Rachel Howes
- Department of Plastic Surgery, John Radcliffe Hospital, Oxford NHS Trust, Oxford, UK
| | - Paul Leighton
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Muhammad Riaz
- Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Cardiff, UK
| | - Jeremy Rodrigues
- Department of Plastic Surgery, Stoke Mandeville Hospital, Buckinghamshire Healthcare Trust, Aylesbury, UK
- Warwick Clinical Trials Unit, University of Warwick, Warwick, UK
| | - Helen Stanton
- Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Cardiff, UK
| | - Kim S Thomas
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Emma Thomas-Jones
- Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Cardiff, UK
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13
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Ben Abdallah H, Bregnhøj A, Emmanuel T, Ghatnekar G, Johansen C, Iversen L. Efficacy and Safety of the Heat Shock Protein 90 Inhibitor RGRN-305 in Hidradenitis Suppurativa: A Parallel-Design Double-Blind Trial. JAMA Dermatol 2024; 160:63-70. [PMID: 38055242 PMCID: PMC10701664 DOI: 10.1001/jamadermatol.2023.4800] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/05/2023] [Indexed: 12/07/2023]
Abstract
Importance Hidradenitis suppurativa is a painful immune-mediated disorder with limited treatment options; hence, a need exists for new treatments. Objective To evaluate the feasibility of heat shock protein 90 inhibition by RGRN-305 as a novel mechanism of action in treating moderate to severe hidradenitis suppurativa. Design, Setting, and Participants This was a parallel-design, double-blind, proof-of-concept, placebo-controlled randomized clinical trial conducted between September 22, 2021, and August 29, 2022, at the Department of Dermatology, Aarhus University Hospital in Denmark. The study included a 1- to 30-day screening period, a 16-week treatment period, and a 4-week follow-up period. Eligibility criteria included age 18 years or older and moderate to severe hidradenitis suppurativa with 6 or more inflammatory nodules or abscesses in at least 2 distinct anatomic regions. Of 19 patients screened, 15 patients were enrolled in the study. Intention-to-treat analysis was performed. Interventions Patients were randomly assigned (2:1) to receive oral RGRN-305, 250-mg tablet, or matching placebo once daily for 16 weeks. Main Outcomes and Measures The primary efficacy end point was the percentage of patients achieving Hidradenitis Suppurativa Clinical Response 50 (HiSCR-50) at week 16. Secondary efficacy end points included HiSCR-75 or HiSCR-90, Hidradenitis Suppurativa Physician's Global Assessment, Dermatology Life Quality Index scores, and a pain numeric rating scale. Safety was assessed by adverse events, physical examinations, clinical laboratory measurements, and electrocardiograms. Results A total of 15 patients were enrolled, completed the study, and were included in all analyses (10 [67%] female; median age, 29 [IQR, 23-41] years). The primary end point HiSCR-50 at week 16 was achieved by a higher percentage in the RGRN-305 group (60% [6 of 10]) than in the placebo group (20% [1 of 5]). Improvements were also observed across all secondary end points at week 16, including higher rates of the harder-to-reach HiSCR levels; 50% (5 of 10) achieved HiSCR-75 and 30% (3 of 10) achieved HiSCR-90, whereas none of the placebo-treated patients achieved HiSCR-75 or HiSCR-90. RGRN-305 was well tolerated, with no deaths or serious adverse events, and treatment-emergent adverse events were similarly frequent between the RGRN-305 and placebo groups. Conclusions and Relevance The findings of this trial suggest that heat shock protein 90 inhibition by RGRN-305 offers a novel mechanism of action in treating hidradenitis suppurativa, warranting further evaluation in larger trials. Trial Registration ClinicalTrials.gov Identifier: NCT05286567.
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Affiliation(s)
- Hakim Ben Abdallah
- Department of Dermatology and Venereology, Aarhus University Hospital, Aarhus, Denmark
| | - Anne Bregnhøj
- Department of Dermatology and Venereology, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas Emmanuel
- Department of Dermatology and Venereology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Claus Johansen
- Department of Dermatology and Venereology, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Iversen
- Department of Dermatology and Venereology, Aarhus University Hospital, Aarhus, Denmark
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Ingram JR, Bates J, Cannings-John R, Collier F, Gibbons A, Harris C, Hood K, Howells L, Howes R, Leighton P, Riaz M, Rodrigues J, Stanton H, Thomas KS, Thomas-Jones E. Treatment of Hidradenitis Suppurativa Evaluation Study: the THESEUS prospective cohort study. Health Technol Assess 2023; 27:1-107. [PMID: 38149635 PMCID: PMC11017627 DOI: 10.3310/hwnm2189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023] Open
Abstract
Background Hidradenitis suppurativa is a chronic inflammatory skin disease characterised by recurrent inflammatory lesions and skin tunnels in flexural sites such as the axilla. Deroofing of skin tunnels and laser treatment are standard hidradenitis suppurativa interventions in some countries but not yet introduced in the United Kingdom. Objective To understand current hidradenitis suppurativa management pathways and what influences treatment choices to inform the design of future randomised controlled trials. Design Prospective 12-month observational cohort study, including five treatment options, with nested qualitative interviews and an end-of-study consensus workshop. Setting Ten United Kingdom hospitals with recruitment led by dermatology and plastic surgery departments. Participants Adults with active hidradenitis suppurativa of any severity not adequately controlled by current treatment. Interventions Oral doxycycline 200 mg once daily; oral clindamycin and rifampicin, both 300 mg twice daily for 10 weeks initially; laser treatment targeting the hair follicle (neodymium-doped yttrium aluminium garnet or alexandrite); deroofing; and conventional surgery. Main outcome measures Primary outcome was the proportion of participants who are eligible, and hypothetically willing, to use the different treatment options. Secondary outcomes included proportion of participants choosing each of the study interventions, with reasons for their choices; proportion of participants who switched treatments; treatment fidelity; loss to follow-up rates over 12 months; and efficacy outcome estimates to inform outcome measure instrument responsiveness. Results Between February 2020 and July 2021, 151 participants were recruited, with two pauses due to the COVID-19 pandemic. Follow-up rates were 89% and 83% after 3 and 6 months, decreasing to 70% and 44% at 9 and 12 months, respectively, because pandemic recruitment delays prevented all participants reaching their final review. Baseline demographics included an average age of 36 years, 81% female, 20% black, Asian or Caribbean, 64% current or ex-smokers and 86% with a raised body mass index. Some 69% had moderate disease, 19% severe disease and 13% mild disease. Regarding the study's primary outcome, laser treatment was the intervention with the highest proportion (69%) of participants who were eligible and hypothetically willing to receive treatment, followed by deroofing (58%), conventional surgery (54%), the combination of oral clindamycin and rifampicin (44%) and doxycycline (37%). Considering participant willingness in isolation, laser was ranked first choice by the greatest proportion (41%) of participants. The cohort study and qualitative study demonstrated that participant willingness to receive treatment was strongly influenced by their clinician. Fidelity to oral doxycycline was only 52% after 3 months due to lack of effectiveness, participant preference and adverse effects. Delays receiving procedural interventions were common, with only 43% and 26% of participants commencing laser therapy and deroofing, respectively, after 3 months. Treatment switching was uncommon and there were no serious adverse events. Daily pain score text messages were initiated in 110 participants. Daily responses reduced over time with greatest concordance during the first 14 days. Limitations It was not possible to characterise conventional surgery due to a low number of participants. Conclusion The Treatment of Hidradenitis Suppurativa Evaluation Study established deroofing and laser treatment for hidradenitis suppurativa in the United Kingdom and developed a network of 10 sites for subsequent hidradenitis suppurativa randomised controlled trials. Future work The consensus workshop prioritised laser treatment and deroofing as interventions for future randomised controlled trials, in some cases combined with drug treatment. Trial registration This trial is registered as ISRCTN69985145. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 12/35/64) and is published in full in Health Technology Assessment; Vol. 27, No. 30. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- John R Ingram
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Janine Bates
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Rebecca Cannings-John
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | | | - Angela Gibbons
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Ceri Harris
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Kerenza Hood
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Laura Howells
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Rachel Howes
- Burns and Plastic Surgery, Stoke Mandeville Hospital, Aylesbury, UK
| | - Paul Leighton
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Muhammad Riaz
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Jeremy Rodrigues
- Burns and Plastic Surgery, Stoke Mandeville Hospital, Aylesbury, UK
- Warwick Clinical Trials Unit, University of Warwick, Warwick, UK
| | - Helen Stanton
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Kim S Thomas
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
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15
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Sabat R, Gudjonsson JE, Brembilla NC, van Straalen KR, Wolk K. Biology of Interleukin-17 and Novel Therapies for Hidradenitis Suppurativa. J Interferon Cytokine Res 2023; 43:544-556. [PMID: 37824200 DOI: 10.1089/jir.2023.0105] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023] Open
Abstract
Skin disorders affect ∼40% of the human population. One of the most debilitating cutaneous disorders is Hidradenitis suppurativa (HS), a noncommunicable chronic inflammatory disease with an estimated global prevalence of 0.4% to 2.5%. In January 2011, high levels of IL-17 were discovered in skin lesions of HS patients. In the following years, translational and clinical research led to a better understanding of the pathogenesis of HS. In June 2023, more than 12 years after the initial note, secukinumab, an anti-IL-17A monoclonal antibody, was approved for the treatment of moderate to severe HS. This is the next milestone in improving the treatment of these patients after the approval of the anti-TNF-α monoclonal antibody adalimumab in 2015. In this review article, we present the IL-17 pathway in HS and discuss the use of secukinumab as a therapeutic option for this disease. Our review starts with a description of the epidemiology, clinical features, etiology, and pathogenesis of HS. An overview of the IL-17/IL-17 receptor system in general and a detailed description of the known facts about the expression and action of IL-17 in HS follow. Afterward, we consider the results of clinical trials evaluating the safety and efficacy of IL-17 inhibitors in HS. Finally, a comparison is made between secukinumab and adalimumab and the characteristics of the patients that may be particularly suitable for each of these biologics are described.
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Affiliation(s)
- Robert Sabat
- Psoriasis Research and Treatment Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Johann Eli Gudjonsson
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
- Taubman Medical Research Institute, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | | | - Kelsey R van Straalen
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Kerstin Wolk
- Psoriasis Research and Treatment Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Mastacouris N, Tannenbaum R, Strunk A, Koptyev J, Aarts P, Alhusayen R, Bechara FG, Benhadou F, Bettoli V, Brassard A, Brown D, Choon SE, Coutts P, da Silva DLF, Daveluy S, Dellavalle RP, Del Marmol V, Emtestam L, Gebauer K, George R, Giamarellos-Bourboulis EJ, Goldfarb N, Hamzavi I, Hazen PG, Horváth B, Hsiao J, Ingram JR, Jemec GBE, Kirby JS, Lowes MA, Marzano AV, Matusiak L, Naik HB, Okun MM, Oon HH, Orenstein LAV, Paek SY, Pascual JC, Fernandez-Peñas P, Resnik BI, Sayed CJ, Thorlacius L, van der Zee HH, van Straalen KR, Garg A. Outcome Measures for the Evaluation of Treatment Response in Hidradenitis Suppurativa for Clinical Practice: A HiSTORIC Consensus Statement. JAMA Dermatol 2023; 159:1258-1266. [PMID: 37755725 DOI: 10.1001/jamadermatol.2023.3282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
Importance Although several clinician- and patient-reported outcome measures have been developed for trials in hidradenitis suppurativa (HS), there is currently no consensus on which measures are best suited for use in clinical practice. Identifying validated and feasible measures applicable to the practice setting has the potential to optimize treatment strategies and generate generalizable evidence that may inform treatment guidelines. Objective To establish consensus on a core set of clinician- and patient-reported outcome measures recommended for use in clinical practice and to establish the appropriate interval within which these measures should be applied. Evidence Review Clinician- and patient-reported HS measures and studies describing their psychometric properties were identified through literature reviews. Identified measures comprised an item reduction survey and subsequent electronic Delphi (e-Delphi) consensus rounds. In each consensus round, a summary of outcome measure components and scoring methods was provided to participants. Experts were provided with feasibility characteristics of clinician measures to aid selection. Consensus was achieved if at least 67% of respondents agreed with use of a measure in clinical practice. Findings Among HS experts, response rates for item reduction, e-Delphi round 1, and e-Delphi round 2 surveys were 76.4% (42 of 55), 90.5% (38 of 42), and 92.9% (39 of 42), respectively; among patient research partners (PRPs), response rates were 70.8% (17 of 24), 100% (17 of 17), and 82.4% (14 of 17), respectively. The majority of experts across rounds were practicing dermatologists with 18 to 19 years of clinical experience. In the final e-Delphi round, most PRPs were female (12 [85.7%] vs 2 males [11.8%]) and aged 30 to 49 years. In the final e-Delphi round, HS experts and PRPs agreed with the use of the HS Investigator Global Assessment (28 [71.8%]) and HS Quality of Life score (13 [92.9%]), respectively. The most expert-preferred assessment interval in which to apply these measures was 3 months (27 [69.2%]). Conclusions and Relevance An international group of HS experts and PRPs achieved consensus on a core set of HS measures suitable for use in clinical practice. Consistent use of these measures may lead to more accurate assessments of HS disease activity and life outcomes, facilitating shared treatment decision-making in the practice setting.
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Affiliation(s)
| | | | | | | | - Pim Aarts
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Raed Alhusayen
- Sunnybrook Research Institute, Division of Dermatology, University of Toronto, Toronto, Ontario, Canada
| | - Falk G Bechara
- Department of Dermatology, Venereology and Allergology, Ruhr-University, Bochum, Germany
| | - Farida Benhadou
- Department of Dermatology, Hôpital Universitaire de Bruxelles, CUB Hôpital Erasme, Université libre de Bruxelles, Brussels, Belgium
| | - Vincenzo Bettoli
- Department of Medical Sciences, O.U. of Dermatology, Azienda Ospedaliera, University of Ferrara, Ferrara, Italy
| | | | - Debra Brown
- Medical Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Siew Eng Choon
- Hospital Sultanah Aminah and Clinical School Johor Bahru, Monash University Malaysia, Johor Bahru, Malaysia
| | | | | | - Steven Daveluy
- Department of Dermatology, Wayne State University, Detroit, Michigan
| | - Robert P Dellavalle
- Department of Dermatology, University of Colorado Anschutz School of Medicine, Aurora, Colorado
- Dermatology Service, Eastern Colorado Health Care System, US Department of Veterans Affairs, Aurora, Colorado
| | - Veronique Del Marmol
- Department of Dermatology, Erasme Hospital, Universite Libre de Bruxelles, Brussels, Belgium
| | - Lennart Emtestam
- Section of Infectious Diseases and Dermatology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Kurt Gebauer
- University of Western Australia, Perth, Western Australia, Australia
| | - Ralph George
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Noah Goldfarb
- Departments of Medicine and Dermatology, University of Minnesota, Minneapolis, Minnesota
| | - Iltefat Hamzavi
- Department of Dermatology, Henry Ford Health System, Detroit, Michigan
| | - Paul G Hazen
- Case-Western Reserve University School of Medicine, Cleveland, Ohio
| | - Barbara Horváth
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Jennifer Hsiao
- Department of Dermatology, University of Southern California, Los Angeles
| | - John R Ingram
- Division of Infection and Immunity, Cardiff University, Cardiff, United Kingdom
| | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Joslyn S Kirby
- Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | | | - Angelo V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lukasz Matusiak
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Haley B Naik
- Department of Dermatology, University of California, San Francisco
| | | | - Hazel H Oon
- National Skin Centre, Singapore, Singapore City, Singapore
- Lee Kong Chian School of Medicine, Singapore City, Singapore
| | - Lauren A V Orenstein
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - So Yeon Paek
- Baylor University Medical Center, Dallas, Texas A&M University School of Medicine, Dallas
| | - José C Pascual
- Dermatology Department, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research, Alicante, Spain
| | - Pablo Fernandez-Peñas
- Department of Dermatology, Westmead Hospital, The University of Sydney, Westmead, New South Wales, Australia
| | - Barry I Resnik
- Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Christopher J Sayed
- Department of Dermatology, University of North Carolina School of Medicine, Chapel Hill
| | - Linnea Thorlacius
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Hessel H van der Zee
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Kelsey R van Straalen
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Amit Garg
- Northwell Health, New Hyde Park, New York
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Aarts P, van Huijstee JC, van der Zee HH, van Doorn MBA, van Straalen KR, Prens EP. Adalimumab in conjunction with surgery compared with adalimumab monotherapy for hidradenitis suppurativa: A Randomized Controlled Trial in a real-world setting. J Am Acad Dermatol 2023; 89:677-684. [PMID: 37116615 DOI: 10.1016/j.jaad.2023.04.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 04/03/2023] [Accepted: 04/07/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND Adalimumab, the only biologic registered for hidradenitis suppurativa, shows clinical response in up to 60% of patients, leaving many patients in need for other treatment options such as surgery. OBJECTIVE To compare the clinical effectiveness of adalimumab combined with surgery vs adalimumab monotherapy in patients with moderate to severe hidradenitis suppurativa. METHODS A pragmatic Randomized Controlled Trial was performed from August 2018 to July 2022. Primary outcome was the difference in mean International Hidradenitis Suppurativa Severity Score System reduction after 12 months of treatment with the difference in mean Dermatology Life Quality Index reduction as a key secondary outcome. RESULTS Thirty-one patients were included per arm. The mean International Hidradenitis Suppurativa Severity Score System at baseline was 23.9 ± 10.7 in the surgery group and 20.9 ± 16.4, in the monotherapy group. After 12 months of treatment the surgery group had a significantly greater reduction in International Hidradenitis Suppurativa Severity Score System compared with the monotherapy group (-19.1 ± 11.3 vs -7.8 ± 11.8, P < .001). Moreover, the surgery group showed a greater reduction in Dermatology Life Quality Index after treatment compared with the monotherapy group (-8.2 ± 6.2 vs -4 ± 7.7, P = .02). LIMITATIONS The study follow-up was too short to assess surgical recurrence rates. DISCUSSION Combining adalimumab with surgery resulted in greater clinical effectiveness and improved quality of life after 12 months in patients with moderate to severe hidradenitis suppurativa.
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Affiliation(s)
- Pim Aarts
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Johanna C van Huijstee
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Hessel H van der Zee
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Martijn B A van Doorn
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Kelsey R van Straalen
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Errol P Prens
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
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18
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Koerts NDK, Bouwman K, Prens LM, Horváth B. Assessment tools and phenotype classification for hidradenitis suppurativa. Clin Dermatol 2023; 41:601-610. [PMID: 37652190 DOI: 10.1016/j.clindermatol.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Hidradenitis suppurativa (HS) is a heterogeneous chronic relapsing skin disease. Several assessment tools are used to assess disease severity and to classify disease phenotype; however, no consensus exists. This review evaluates the various assessment tools and phenotypes, assessing their validity and reliability. Numerous assessment tools and phenotype classifications have been proposed for identifying various subtypes within the hidradenitis suppurativa disease spectrum. Each has a different purpose, such as use in daily practice or in clinical trial settings. Several assessment tools and phenotype classifications have been validated but not always with satisfactory results and often with studies showing divergent intra-rater reliability results. A consensus is needed for a validated, easy-to-use, and timesaving assessment tool for routine daily practice. For clinical trials, a validated and extensive assessment tool that also measures response to treatment is also needed.
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Affiliation(s)
- Nicole D K Koerts
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Klasiena Bouwman
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lisette M Prens
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Barbara Horváth
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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19
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Damsin T. A Case of Concurrent Psoriasis and Hidradenitis Suppurativa Successfully Treated with Tildrakizumab. Dermatol Ther (Heidelb) 2023:10.1007/s13555-023-00940-0. [PMID: 37266889 DOI: 10.1007/s13555-023-00940-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 05/11/2023] [Indexed: 06/03/2023] Open
Abstract
INTRODUCTION Plaque psoriasis and hidradenitis suppurativa are chronic inflammatory skin conditions with common pathogenetic pathways. METHODS We report the case of a 38-year-old man with 15-year history of psoriasis and hidradenitis suppurativa successfully treated with tildrakizumab for both conditions. After treatment failure to adalimumab, secukinumab, and guselkumab, tildrakizumab therapy was initiated and resulted in complete remission of psoriasis and the achievement of hidradenitis suppurativa clinical response after 40 weeks, without reporting adverse events. These responses were maintained at week 52. CONCLUSION Tildrakizumab may be an effective and safe therapeutic option for concomitant psoriasis and hidradenitis suppurativa.
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Affiliation(s)
- Thomas Damsin
- Department of Dermatology, CHU du Sart Tilman, Avenue de L'Hôpital 1, 4000, Liège, Belgium.
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20
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Tsai YC, Hung CY, Tsai TF. Efficacy and Safety of Biologics and Small Molecules for Moderate-to-Severe Hidradenitis Suppurativa: A Systematic Review and Network Meta-Analysis. Pharmaceutics 2023; 15:pharmaceutics15051351. [PMID: 37242593 DOI: 10.3390/pharmaceutics15051351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/16/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
Background: Treatment of hidradenitis suppurativa (HS) is difficult and current guidelines are based mainly on expert opinion and non-randomized controlled trials. Recently, there have been some targeted therapies using uniform primary endpoints for outcome assessment. Objective: Recommendations can be provided on selecting biologics and targeted synthetic small molecules for refractory HS by comparing the efficacy and safety of these medications. Methods: Databases including ClinicalTrial.gov, Cochrane Library, and PubMed were searched. Randomized controlled trials (RCTs) for moderate-to-severe HS were eligible. We performed random-effect network meta-analysis and ranking probability. The primary outcome was Hidradenitis Suppurativa Clinical Response (HiSCR) at 12-16 weeks. Secondary outcome included Dermatology Life Quality Index (DLQI) 0/1, mean change of DLQI from baseline, and adverse effects. Results: A total of 12 RCTs involving 2915 patients were identified. Adalimumab, bimekizumab, secukinumab 300 mg q4w and secukinumab 300 mg q2w showed superiority to placebo in HiSCR at weeks 12 to 16. In addition, there was no significant difference between bimekizumab and adalimumab as measured by HiSCR (RR = 1.00; 95% CI: 0.66-1.52) and DLQI 0/1 (RR = 2.40, 95% CI: 0.88-6.50). In terms of ranking probability for achieving HiSCR at 12-16 weeks, adalimumab ranked first, followed by bimekizumab, secukinumab 300 mg q4w, and secukinumab 300 mg q2w. All biologics and small molecules did not differ in the development of adverse effects compared to placebo. Conclusions: Adalimumab, bimekizumab, secukinumab 300 mg q4w and secukinumab 300 mg q2w represent four regimens that produce better outcomes than placebo without increased risk of adverse events. Adalimumab and bimekizumab exhibited best HiSCR and DLQI 0/1 between weeks 12-16.
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Affiliation(s)
- Ya-Chu Tsai
- Department of Dermatology, Far Eastern Memorial Hospital, New Taipei 220, Taiwan
- Department of Fashion Styling and Design, Minghsin University of Science and Technology, Hsinchu 30401, Taiwan
| | - Chen-Yiu Hung
- Department of Thoracic Medicine, Chang Gung University College of Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan
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21
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Kimball AB, Jemec GBE, Alavi A, Reguiai Z, Gottlieb AB, Bechara FG, Paul C, Giamarellos Bourboulis EJ, Villani AP, Schwinn A, Ruëff F, Pillay Ramaya L, Reich A, Lobo I, Sinclair R, Passeron T, Martorell A, Mendes-Bastos P, Kokolakis G, Becherel PA, Wozniak MB, Martinez AL, Wei X, Uhlmann L, Passera A, Keefe D, Martin R, Field C, Chen L, Vandemeulebroecke M, Ravichandran S, Muscianisi E. Secukinumab in moderate-to-severe hidradenitis suppurativa (SUNSHINE and SUNRISE): week 16 and week 52 results of two identical, multicentre, randomised, placebo-controlled, double-blind phase 3 trials. Lancet 2023; 401:747-761. [PMID: 36746171 DOI: 10.1016/s0140-6736(23)00022-3] [Citation(s) in RCA: 101] [Impact Index Per Article: 101.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/14/2022] [Accepted: 12/28/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Few therapeutic options are available for patients with moderate-to-severe hidradenitis suppurativa. We aimed to assess the efficacy of secukinumab in patients with moderate-to-severe hidradenitis suppurativa in two randomised trials. METHODS SUNSHINE and SUNRISE were identical, multicentre, randomised, placebo-controlled, double-blind phase 3 trials done in 219 primary sites in 40 countries. Patients aged 18 years old or older with the capacity to provide written informed consent and with moderate-to-severe hidradenitis suppurativa (defined as a total of ≥5 inflammatory lesions affecting ≥2 distinct anatomical areas) for at least 1 year were eligible for inclusion. Included patients also agreed to daily use of topical over-the-counter antiseptics on the areas affected by hidradenitis suppurativa lesions while on study treatment. Patients were excluded if they had 20 or more fistulae at baseline, had ongoing active conditions requiring treatment with prohibited medication (eg, systemic biological immunomodulating treatment, live vaccines, or other investigational treatments), or met other exclusion criteria. In both trials, patients were randomly assigned (1:1:1) by means of interactive response technology to receive subcutaneous secukinumab 300 mg every 2 weeks, subcutaneous secukinumab 300 mg every 4 weeks, or subcutaneous placebo all via a 2 mL prefilled syringe in a double-dummy method as per treatment assignment. The primary endpoint was the proportion of patients with a hidradenitis suppurativa clinical response, defined as a decrease in abscess and inflammatory nodule count by 50% or more with no increase in the number of abscesses or in the number of draining fistulae compared with baseline, at week 16, assessed in the overall population. Hidradenitis suppurativa clinical response was calculated based on the number of abscesses, inflammatory nodules, draining fistulae, total fistulae, and other lesions in the hidradenitis suppurativa affected areas. Safety was assessed by evaluating the presence of adverse events and serious adverse events according to common terminology criteria for adverse events, which were coded using Medical Dictionary for Regulatory Activities terminology. Both the SUNSHINE, NCT03713619, and SUNRISE, NCT03713632, trials are registered with ClinicalTrials.gov. FINDINGS Between Jan 31, 2019, and June 7, 2021, 676 patients were screened for inclusion in the SUNSHINE trial, of whom 541 (80%; 304 [56%] women and 237 [44%] men; mean age 36·1 years [SD 11·7]) were included in the analysis (181 [33%] in the secukinumab every 2 weeks group, 180 [33%] in the secukinumab every 4 weeks group, and 180 [33%] in the placebo group). Between the same recruitment dates, 687 patients were screened for inclusion in the SUNRISE trial, of whom 543 (79%; 306 [56%] women and 237 [44%] men; mean age 36·3 [11·4] years) were included in the analysis (180 [33%] in the secukinumab every 2 weeks group, 180 [33%] in the secukinumab every 4 weeks group, and 183 [34%] in the placebo group). In the SUNSHINE trial, significantly more patients in the secukinumab every 2 weeks group had a hidradenitis suppurativa clinical response (rounded average number of patients with response in 100 imputations, 81·5 [45%] of 181 patients) compared with the placebo group (60·7 [34%] of 180 patients; odds ratio 1·8 [95% CI 1·1-2·7]; p=0·0070). However, there was no significant difference between the number of patients in the secukinumab every 4 weeks group (75·2 [42%] of 180 patients) and the placebo group (1·5 [1·0-2·3]; p=0·042). Compared with the placebo group (57·1 [31%] of 183 patients), significantly more patients in the secukinumab every 2 weeks group (76·2 [42%] of 180 patients; 1·6 [1·1-2·6]; p=0·015) and the secukinumab every 4 weeks group (83·1 [46%] of 180 patients; 1·9 [1·2-3·0]; p=0·0022) had a hidradenitis suppurativa clinical response in the SUNRISE trial. Patient responses were sustained up to the end of the trials at week 52. The most common adverse event by preferred term up to week 16 was headache in both the SUNSHINE (17 [9%] patients in the secukinumab every 2 weeks group, 20 [11%] in the secukinumab every 4 weeks group, and 14 [8%] in the placebo group) and SUNRISE (21 [12%] patients in the secukinumab every 2 weeks group, 17 [9%] in the secukinumab every 4 weeks group, and 15 [8%] in the placebo group) trials. No study-related deaths were reported up to week 16. The safety profile of secukinumab in both trials was consistent with that previously reported, with no new or unexpected safety findings detected. INTERPRETATION When given every 2 weeks, secukinumab was clinically effective at rapidly improving signs and symptoms of hidradenitis suppurativa with a favourable safety profile and with sustained response up to 52 weeks of treatment. FUNDING Novartis Pharma.
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Affiliation(s)
- Alexa B Kimball
- Harvard Medical School and Clinical Laboratory for Epidemiology and Applied Research in Skin, Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Ziad Reguiai
- Dermatology Department, Polyclinique Courlancy-Bezannes, Reims, France
| | - Alice B Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Falk G Bechara
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Carle Paul
- Department of Dermatology, INSERM Infinity, Toulouse University, Toulouse, France
| | | | - Axel P Villani
- Department of Dermatology, Edouard Herriot Hospital, Hospices Civils de Lyon, Claude Bernard Lyon I University, Lyon, France
| | | | - Franziska Ruëff
- Department of Dermatology and Allergy, University Hospital Ludwig Maximilian University of Munich, Munich, Germany
| | | | - Adam Reich
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszów, Poland
| | - Ines Lobo
- Centro Hospitalar do Porto, Hospital de Santo Antonio Porto, Porto, Portugal
| | | | - Thierry Passeron
- Department of Dermatology Centre Hospitalier Universitaire de Nice, C3M, INSERM U1065, Côte d'Azur University, Nice, France
| | | | - Pedro Mendes-Bastos
- Dermatology Centre, Hospital Companhia União Fabril Descobertas, Lisbon, Portugal
| | - Georgios Kokolakis
- Psoriasis Research and Treatment Center, Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Pierre-Andre Becherel
- Department of Dermatology, Venereology and Allergology, Antony Private Hospital, Antony, France
| | | | | | | | | | | | | | | | | | - Li Chen
- Novartis Pharmaceuticals, East Hanover, NJ, USA
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22
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Cabete J, Aparício Martins I. [Guidelines for the Management of Patients with Hidradenitis Suppurativa]. ACTA MEDICA PORT 2023; 36:133-139. [PMID: 36738185 DOI: 10.20344/amp.18916] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/14/2022] [Indexed: 02/04/2023]
Abstract
Hidradenitis suppurativa is a chronic and recurrent inflammatory dermatosis characterized by the presence of inflammatory nodules and abscesses in the apocrine gland-rich areas that may progress to suppurative fistulas and scars. Despite being considered one of the dermatological conditions with the greatest impact on patient quality of life, it is often underdiagnosed. Hidradenitis suppurativa, especially in its severe forms, is associated with numerous comorbidities, so a holistic and multidisciplinary perspective is crucial for the management of these patients. The therapeutic approach is complex and challenging. The medical treatment options are diverse and must be adapted to clinical presentation and disease severity. Surgical therapy should be considered as an adjuvant to medical treatment, particularly in refractory cases and in the presence of scars or anatomical and/or functional mutilation. These recommendations reflect the main aspects of the management of the patient with hidradenitis suppurativa and are addressed to all healthcare professionals who take part in their follow-up.
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Affiliation(s)
- Joana Cabete
- Serviço de Dermatovenereologia. Hospital de Santo António dos Capuchos. Centro Hospitalar Universitário de Lisboa Central. Lisboa. Portugal
| | - Inês Aparício Martins
- Serviço de Dermatovenereologia. Hospital de Santo António dos Capuchos. Centro Hospitalar Universitário de Lisboa Central. Lisboa. Portugal
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23
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Tzellos T, van Straalen KR, Kyrgidis A, Alavi A, Goldfarb N, Gulliver W, Jemec GBE, Lowes MA, Marzano AV, Prens EP, Sayed CJ, van der Zee HH, Zouboulis CC. Development and validation of IHS4-55, an IHS4 dichotomous outcome to assess treatment effect for hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2023; 37:395-401. [PMID: 36184889 DOI: 10.1111/jdv.18632] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/13/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Validated, inclusive and easy-to-use outcomes for hidradenitis suppurativa are essential both in the clinical trial setting and clinical practice. The continuous IHS4 is a validated tool that dynamically assesses nodules/abscesses/draining tunnels and classifies disease severity as mild/moderate/severe. However, dichotomous outcomes are often required for clinical trials reporting. OBJECTIVE To develop and validate a dichotomous outcome based on IHS4 that can be used in clinical trial settings and day-to-day clinical practice. METHODS De-identified data from the PIONEER-I and -II studies were accessed through Vivli. Potential IHS4 thresholds were analysed using baseline to Week 12 data from adalimumab- and placebo-treated hidradenitis suppurativa patients in the PIONEER-I trial. The final threshold was chosen based on its ability to discriminate between patients treated with adalimumab or placebo and its association with reduction in inflammatory lesions. The final threshold was validated using data from baseline to Week 12 from adalimumab- and placebo-treated hidradenitis suppurativa patients in both the PIONEER-II and the combined PIONEER-I and -II studies. RESULTS The best performing cut-off for the IHS4 was a 55% reduction of the IHS4 score (IHS4-55). Patients who achieved the IHS4-55 had an odd's ratio of 2.00 [95%-CI 1.26-3.18, p = 0.003], 2.79 (95%-CI 1.76-4.43, p < 0.001) and 2.16 (95%-CI 1.43-3.29, p < 0.001) for being treated with adalimumab rather than placebo in PIONEER-I, PIONEER-II and the combined dataset, respectively. Additionally, the achievement of the IHS4-55 was associated with a significant reduction in inflammatory nodules, abscesses and draining tunnels in all analysed datasets. CONCLUSIONS IHS4-55, a novel dichotomous IHS4 version, based on a 55% reduction of the total score was developed. The IHS4-55 performs similarly to the HiSCR in discriminating between adalimumab- and placebo-treated hidradenitis suppurativa patients and shows significant associations with reductions in lesion counts. Moreover, the IHS4-55 addresses some of the HiSCR drawbacks by dynamically including draining tunnels in a validated manner. By allowing the analysis of hidradenitis suppurativa patients with an abscess and nodule count below 3 but many draining tunnels, this outcome measure will improve inclusivity in clinical trials.
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Affiliation(s)
- Thrasivoulos Tzellos
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany.,Department of Dermatology, Nordland Hospital Trust, Bodø, Norway
| | - Kelsey R van Straalen
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany.,Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Athanassios Kyrgidis
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany.,Department of Maxillofacial Surgery, Papanikolaou General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Afsaneh Alavi
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany.,Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Noah Goldfarb
- Departments of Medicine and Dermatology, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA.,Departments of Medicine and Dermatology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Wayne Gulliver
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany.,Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Gregor B E Jemec
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany.,Department of Dermatology, Zealand University Hospital, Roskilde and Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | | | - Angelo Valerio Marzano
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany.,Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Errol P Prens
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany.,Department of Dermatology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Christopher J Sayed
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Hessel H van der Zee
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany.,Department of Dermatology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Christos C Zouboulis
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany.,Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
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24
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Current Medical and Surgical Treatment of Hidradenitis Suppurativa-A Comprehensive Review. J Clin Med 2022; 11:jcm11237240. [PMID: 36498816 PMCID: PMC9737445 DOI: 10.3390/jcm11237240] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 11/30/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease presenting with recurrent inflammatory lesions in intertriginous body regions. HS has a pronounced impact on patients' quality of life and is associated with a variety of comorbidities. Treatment of HS is often complex, requiring an individual approach with medical and surgical treatments available. However, especially in moderate-to-severe HS, there is an urgent need for new treatment approaches. In recent years, increased research has led to the identification of new potential therapeutic targets. This review aims to give a comprehensive and practical overview of current treatment options for HS. Furthermore, the clinically most advanced novel treatment approaches will be discussed.
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25
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Garg A, Zema C, Kim K, Gao W, Chen N, Jemec GB, Kirby J, Thorlacius L, Villumsen B, Ingram JR. Development and initial validation of the HS-IGA: a novel hidradenitis suppurativa-specific investigator global assessment for use in interventional trials. Br J Dermatol 2022; 187:203-210. [PMID: 35599448 PMCID: PMC9542331 DOI: 10.1111/bjd.21236] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 12/23/2021] [Accepted: 03/03/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Few validated instruments exist for use in hidradenitis suppurativa (HS) trials. OBJECTIVES To develop a novel HS Investigator Global Assessment (HS-IGA) and to validate its psychometric properties. METHODS Development of HS-IGA involved discussion among stakeholders, including patients, within HISTORIC. Data from replicate phase III randomized controlled trials evaluating HS treatment were utilized. Multivariate models identified lesion type and body region as variables of importance. Classification and regression trees for ordinal responses were built. Validation included assessment of test-retest reliability, predictive validity, responsiveness and clinical meaningfulness. RESULTS There were 3024 unique measurements available in PIONEER I. Mean and median lesion counts by region were largely <10 and were highest in axillary and inguinal regions. The mean and median number of regions involved were ≤ 3 for individual lesions and combinations. Regardless of lesion type, axillary and inguinal regions most influenced the HS-IGA score. Accordingly, regions were combined into a six-point IGA based on the maximum lesion number in either upper or lower body regions with a score of 0 (0-1 lesions), 1 (2-5), 2 (6-10), 3 (11-15), 4 (16-20) and 5 (≥ 20 lesions). The intraclass correlation coefficient for test-retest reliability was 0·91 (95% confidence interval 0·87-0·94). Spearman's rank order correlations (SROCs) with HS-PGA and Hidradenitis Suppurativa Clinical Response (HiSCR) were 0·73 and 0·51, respectively (P < 0·001 for both comparisons). SROCs with Dermatology Life Quality Index (DLQI), pain numerical rating scale and HS-QoL were 0·42, 0·34 and -0·25, respectively (P < 0·001 for all comparisons). HS-IGA was responsive at weeks 12 and 36. Predictive convergent validity was very good with HS-PGA (area under the curve = 0·89) and with HiSCR (area under the curve = 0·82). Predictive divergent validity was low with DLQI and HS-QoL. CONCLUSIONS HS-IGA has moderate-to-strong psychometric properties and is simple to calculate.
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Affiliation(s)
- Amit Garg
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell1991 Marcus Avenue, Suite 300New Hyde ParkNY11042USA
| | | | - Katherine Kim
- AbbVie, Inc.1 North Waukegan StNorth ChicagoIL60064USA
| | - Weihua Gao
- AbbVie, Inc.1 North Waukegan StNorth ChicagoIL60064USA
| | - Naijun Chen
- AbbVie, Inc.1 North Waukegan StNorth ChicagoIL60064USA
| | - Gregor B.E. Jemec
- Department of DermatologyZealand University HospitalSygehusvej 10RoskildeDK‐4000Denmark
| | - Joslyn Kirby
- Penn State Health500 University DriveHersheyPA17033USA
| | - Linnea Thorlacius
- Department of DermatologyZealand University HospitalSygehusvej 10RoskildeDK‐4000Denmark
| | | | - John R. Ingram
- Division of Infection and ImmunityCardiff UniversityCardiffUK
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Speeckaert R, Belpaire A, Herbelet S, Speeckaert MM, van Geel N. The Meaning and Reliability of Minimal Important Differences (MIDs) for Clinician-Reported Outcome Measures (ClinROMs) in Dermatology-A Scoping Review. J Pers Med 2022; 12:jpm12071167. [PMID: 35887664 PMCID: PMC9321211 DOI: 10.3390/jpm12071167] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 07/16/2022] [Accepted: 07/16/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Clinician-reported outcome measures (ClinROMs) are frequently used in clinical trials and daily practice to evaluate the disease status and evolution of skin disorders. The minimal important difference (MID) represents the smallest difference that decreases the disease impact enough to make a treatment change worthwhile for patients. As no clear guidance exists on the preferred method to calculate MIDs for ClinROMs, we evaluated how the published values for different skin disorders should be interpreted. Methods: A systematic search was performed for MIDs of ClinROMs that focus on skin disorders and/or symptoms. The results of the questions in the credibility instrument for MIDs of Devji et al., 2020 were analyzed to gain insights into the meaning of these MIDs. Results: 29 MIDs were identified. The most common skin diseases were atopic dermatitis/eczema, followed by bullous disorders and psoriasis. A minimal important difference from the patients’ perspective was determined in 31% of the cases. However, in 41.4% of the cases, it concerned a substantial rather than a minimal difference in disease severity rated by physicians. Over half (55.1%) of the studies contained an inadequate number of patients (n < 150). MID values increased substantially in patients with severe compared to mild disease. Conclusions: MIDs of ClinROMs for skin disorders should be carefully interpreted due to the substantial differences in methodology between the studies. There is an urgent need for a consensus method to report reliable MIDs. Otherwise, this lack of uniformity could not only affect the design and conclusion of clinical trials but also skew treatment decisions.
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Affiliation(s)
- Reinhart Speeckaert
- Department of Dermatology, Ghent University Hospital, 9000 Ghent, Belgium; (A.B.); (S.H.); (N.v.G.)
- Correspondence:
| | - Arno Belpaire
- Department of Dermatology, Ghent University Hospital, 9000 Ghent, Belgium; (A.B.); (S.H.); (N.v.G.)
| | - Sandrine Herbelet
- Department of Dermatology, Ghent University Hospital, 9000 Ghent, Belgium; (A.B.); (S.H.); (N.v.G.)
| | | | - Nanja van Geel
- Department of Dermatology, Ghent University Hospital, 9000 Ghent, Belgium; (A.B.); (S.H.); (N.v.G.)
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van Straalen KR, Ingram JR, Augustin M, Zouboulis CC. New treatments and new assessment instruments for hidradenitis suppurativa. Exp Dermatol 2022; 31 Suppl 1:33-39. [PMID: 35582833 PMCID: PMC9542859 DOI: 10.1111/exd.14609] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/08/2022] [Accepted: 05/15/2022] [Indexed: 11/26/2022]
Abstract
Research interest in Hidradenitis Suppurativa (HS) has grown exponentially over the past decades. Several groups have worked to develop novel scores that address the drawbacks of existing investigator assessed and patient reported outcome measures currently used in HS trials, clinical practice and research. In clinical trial settings, the drawbacks of the HiSCR have become apparent; mainly it's lack of a dynamic measurement of draining tunnels. The newly developed (dichotomous) IHS4 and HASI-R are backed up by adequate validation data and are good contenders to become the new primary outcome measure in HS clinical trials. Patient reported outcomes, as well as physician reported measures, are being developed by the HIdradenitis SuppuraTiva cORe outcomes set International Collaboration (HISTORIC). For example, the Hidradenitis Suppurativa Quality of Life (HiSQOL) score is a validated measure of HS-specific quality of life and is already being used in many HS trials. Magnitude of pain measurement via a 0-10 numerical rating scale is well-established, however consensus is still required to ensure consistent administration and interpretation of the instrument. A longitudinal measurement over multiple days rather than at one time point, such as for example the Pain Index could provide increased reliability and reduced recall bias. Ultimately, these newly developed scores and tools can be included in a standardized registry to be used in routine clinical practice.
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Affiliation(s)
- K R van Straalen
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA.,European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - J R Ingram
- Department of Dermatology, Division of Infection & Immunity, Cardiff University, Cardiff, UK.,European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - M Augustin
- Institute for Health Care Services Research in Dermatology and Nursing, University Hospital Medical Center Hamburg-Eppendorf, Hamburg, Germany.,European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - C C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany.,European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
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28
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Gulliver W, Alavi A, Wiseman MC, Gooderham MJ, Rao J, Shayesteh Alam M, Papp KA, Desjardins O, Jean C. Real-World Moderate-to-Severe Hidradenitis Suppurativa: Decrease in Disease Burden With Adalimumab. J Cutan Med Surg 2022; 26:361-370. [PMID: 35322692 DOI: 10.1177/12034754221088584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Real-world knowledge of the burden of hidradenitis suppurativa (HS) on patients remains limited. OBJECTIVES To measure the impact of adalimumab on moderate-to-severe HS patients' health-related quality of life (HRQoL) and work productivity. METHODS In 23 Canadian centres, 138 adults with moderate-to-severe HS requiring a change in ongoing therapy were treated with adalimumab for up to 52 weeks as per the physician's practice. Patient-reported outcome measures (PROMs) were obtained at baseline, weeks 24 and 52 to measure overall HRQoL, HS severity, levels of anxiety and depression, impact and symptoms of HS, work productivity and activity impairment. A post-hoc analysis further explored the PROMs by abscess and inflammatory nodule (AN) count at baseline (≤5, low; 6-10, medium; ≥11, high). RESULTS From baseline to weeks 24 and 52, all PRO overall scores improved significantly (P ≤ .0023). The number of patients reporting "good disease control" and "complete disease control" increased from 9.7% to 66.4% over 52 weeks. The score in Health Utility Index Mark 3 (HUI3) pain attribute meaningfully decreased over 52 weeks (mean difference ≥.05). The HS symptoms skin "tenderness" and "itchiness" improved the most. Work productivity loss and activity impairment improved by approximately 20% over 52 weeks. Disease burden improved more in 24 week responders with low and medium AN counts at baseline than in those with high AN count or in 24 week nonresponders. CONCLUSION At week 24 and maintained at week 52 in a real-world setting, adalimumab meaningfully improved HRQoL, work productivity, and activity impairment in moderate-to-severe HS patients.
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Affiliation(s)
- Wayne Gulliver
- NewLab Clinical Research Inc, St. John's, NL, Canada.,Faculty of Medicine, Memorial University of Newfoundland, NL, Canada
| | - Afsaneh Alavi
- 6915 Department of Dermatology, Mayo Clinic, Rochester, MN, USA.,468790 Probity Medical Research Inc, Waterloo, ON, Canada
| | - Marni C Wiseman
- 468790 Probity Medical Research Inc, Waterloo, ON, Canada.,Department of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Wiseman Dermatology Research, Winnipeg, Canada
| | - Melinda J Gooderham
- 468790 Probity Medical Research Inc, Waterloo, ON, Canada.,SKiN Centre for Dermatology, Peterborough, ON, Canada.,Queen's University, Kingston, ON, Canada
| | - Jaggi Rao
- 468790 Probity Medical Research Inc, Waterloo, ON, Canada.,Division of Dermatology, University of Alberta, Edmonton, AB, Canada
| | - Maryam Shayesteh Alam
- 468790 Probity Medical Research Inc, Waterloo, ON, Canada.,SimcoMed Health Ltd, Barrie, ON, Canada
| | - Kim A Papp
- 468790 Probity Medical Research Inc, Waterloo, ON, Canada.,Kim Papp Clinical Research, Waterloo, ON, Canada
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29
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Hayashi N, Hayama K, Takahashi K, Kurokawa I, Okazaki M, Kashiwagi T, Iwashita E, Terui T. Real-world safety and effectiveness of adalimumab in patients with hidradenitis suppurativa: 12-week interim analysis of post-marketing surveillance in Japan. J Dermatol 2022; 49:411-421. [PMID: 35040156 PMCID: PMC9305509 DOI: 10.1111/1346-8138.16297] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/19/2021] [Accepted: 12/21/2021] [Indexed: 11/28/2022]
Abstract
Hidradenitis suppurativa (HS) is a painful chronic skin disease characterized by abscesses, nodules, and tunnels in the skin. Adalimumab, a monoclonal antibody against tumor necrosis factor‐α, is approved for the treatment of HS in Europe, the USA, and Japan. This multicenter, open‐label, post‐marketing, observational study (ClinicalTrials.gov: NCT03894956) evaluated the safety and effectiveness of adalimumab in routine clinical practice in Japan (March 2019–May 2021). Patients with HS were treated with s.c. doses of adalimumab according to the dosage described in the package insert. The primary end‐point was safety (data cut‐off, December 2020). Secondary end‐points assessed effectiveness, including HS Clinical Response (HiSCR), skin pain, Dermatology Life Quality Index (DLQI), and C‐reactive protein (CRP). Here, we report 12‐week interim effectiveness results. A total of 84 eligible patients from 65 sites were enrolled; 83 patients were included in this analysis. Mean age was 42.0 years, mean body mass index was 26.9 kg/m2, 78.3% of patients were male, 61.4% had Hurley stage III disease, 39.8% had a disease duration ≥10 years, and 7.2% had a family history of HS. The most common affected sites were the axilla (60.2%), buttocks (59.0%), and the inguinal and femoral regions (47.0%). Mean abscess and inflammatory nodule count was 13.0 (standard deviation, 12.0). Among patients with a comorbidity (57.8%), the most common were diabetes mellitus, hypertension, and chronic kidney disease. No patient reported a serious infection or any safety event of special interest. One patient died from a serious adverse event of cardiac failure unrelated to adalimumab. At week 12, 57.4% of patients achieved HiSCR, and significant reductions from baseline in skin pain, DLQI (both p < 0.0001), and CRP (p = 0.0029) were observed. These results support the administration of adalimumab as a well‐tolerated and effective treatment for Japanese patients with HS in real‐world clinical practice.
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30
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van der Zee HH, van de Bunte M, van Straalen KR. Management of mild hidradenitis suppurativa: our greatest challenge yet. Br J Dermatol 2021; 186:355-356. [PMID: 34608630 PMCID: PMC9298862 DOI: 10.1111/bjd.20780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/28/2021] [Accepted: 09/30/2021] [Indexed: 11/28/2022]
Affiliation(s)
- H H van der Zee
- Erasmus University Medical Center Rotterdam, Department of Dermatology, Rotterdam, the Netherlands
| | - M van de Bunte
- Chairperson, Dutch Hidradenitis Patient Association (Hidradenitis Patiënten Vereniging, HPV), Apeldoorn, the Netherlands
| | - K R van Straalen
- Erasmus University Medical Center Rotterdam, Department of Dermatology, Rotterdam, the Netherlands
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31
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Saito-Sasaki N, Sawada Y, Sato S, Sugino H, Minokawa Y, Nanamori H, Yamamoto K, Okada E, Nakamura M. Possible beneficial impact of surgical deroofing procedure to cover the disadvantage of adalimumab treatment for hidradenitis suppurativa. J Dermatol 2021; 49:e3-e4. [PMID: 34514647 DOI: 10.1111/1346-8138.16146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 08/20/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Natsuko Saito-Sasaki
- Department of Dermatology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yu Sawada
- Department of Dermatology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Sayaka Sato
- Department of Dermatology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Hitomi Sugino
- Department of Dermatology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yoko Minokawa
- Department of Dermatology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Hikaru Nanamori
- Department of Dermatology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kayo Yamamoto
- Department of Dermatology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Etsuko Okada
- Department of Dermatology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Motonobu Nakamura
- Department of Dermatology, University of Occupational and Environmental Health, Kitakyushu, Japan
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32
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Fabbrocini G, Ruina G, Giovanardi G, Dini V, Raone B, Venturini M, Caposiena Caro RD, Veraldi S, Cannavò SP, Merlo G, Bertoldi AM, Fiorentini F, Molinelli E, Atzori L, Bongiorno MR, Lo Re M, Skroza N, Lasagni C, Franchi C, Ardigò M, Di Costanzo L, Stingeni L, Amerio P, Sanna F, Pescitelli L, Broganelli P, De Cupis C, Gualberti G, Saragaglia V, Argenziano G. Hidradenitis Suppurativa in a Large Cohort of Italian Patients: Evaluation of the Burden of Disease. Dermatology 2021; 238:487-497. [PMID: 34474409 DOI: 10.1159/000517412] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 05/25/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic, inflammatory, recurrent, debilitating skin disease of the hair follicle that usually occurs after puberty with painful, deep-seated, inflamed nodules and sinus tracts in the apocrine gland-bearing areas of the body, most commonly the axillae and inguinal and anogenital regions, with a relevant impact on patients' quality of life (QoL). OBJECTIVE To evaluate how the burden of HS disease impacts on patient well-being and working activities in a large Italian population over a period of 9 months. METHODS A multicenter, prospective, epidemiologic cohort study was conducted in adult Italian patients with HS. HS severity was assessed through Hurley stage and HS Physician's Global Assessment (HS-PGA), clinical improvement by HS Clinical Response (HiSCR) and partial response, and disease burden through QoL questionnaires (HIDRAdisk, Skindex-16, Dermatology Life Quality Index [DLQI]), and Work Productivity and Activity Impairment - General Health (WPAI:GH). RESULTS A total of 308 patients (56.2% women; mean age 35.2 ± 12.9 years) were enrolled in 27 dermatologic clinics. Men were older (37.4 years vs. 33.5), more smoking addicted (74.1% vs. 60.1%), and alcohol consumer (34.1% vs. 13.9%), while more women were obese (34.10% vs. 22.22%). At baseline, most patients had a Hurley severity stage of 2 (43.9%), a moderate HS-PGA score (57.1%), and poor QoL (HIDRAdisk: 65.7 ± 23.3, Skindex-16: 60.3 ± 26.9, and DLQI: 10.8 ± 8.1). Patients with more severe disease showed worse QoL. Mean values for the variables related to HS severity decreased during the study period. The achievement of HiSCR and partial response increased during the study. CONCLUSION This study offers insight into the disease burden of HS in an Italian population. Our results underline the impact of QoL evaluation, also with the use of the HIDRAdisk, in clinical routine as a support to validated severity clinical and instrumental indexes for a "360-degree" assessment of HS patient's burden of disease.
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Affiliation(s)
- Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico, Naples, Italy
| | - Giulia Ruina
- Royal London Hospital, Barts NHS Trust, London, United Kingdom
| | - Giulia Giovanardi
- Istituto di Dermatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Beatrice Raone
- Department of Specialized, Diagnostic and Experimental Medicine, Division of Dermatology, University of Bologna, Bologna, Italy
| | - Marina Venturini
- Department of Dermatology, University of Brescia and ASST-Spedali Civili Hospital, Brescia, Italy
| | | | - Stefano Veraldi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Foundation IRCCS Cà Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Giulia Merlo
- Dermatology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | | | | | - Elisa Molinelli
- Dermatological Unit, Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | - Laura Atzori
- Dermatology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Maria Rita Bongiorno
- U.O.C. Dermatologia e MTS, Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE), Università di Palermo, Palermo, Italy
| | - Michele Lo Re
- U.O.C di Dermatologia Azienda Ospedaliera Papardo, Messina, Italy
| | - Nevena Skroza
- Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Polo Pontino, Italy
| | - Claudia Lasagni
- Clinica Dermatologica, A.O.U. Policlinico di Modena, Modena, Italy
| | | | | | - Luisa Di Costanzo
- UOC di Dermatologia Azienda Ospedaliera San Pio Presidio G. Rummo, Benevento, Italy
| | - Luca Stingeni
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Paolo Amerio
- Department of Dermatology, University of Chieti-Pescara, Chieti, Italy
| | | | - Leonardo Pescitelli
- Department Health Science Section of Dermatology, University of Florence, Florence, Italy
| | - Paolo Broganelli
- Dermatologia, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
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33
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Frew JW, Jiang CS, Singh N, Navrazhina K, Vaughan R, Krueger JG. Quantifying the natural variation in lesion counts over time in untreated hidradenitis suppurativa: Implications for outcome measures and trial design. JAAD Int 2021; 1:208-221. [PMID: 34409342 PMCID: PMC8361889 DOI: 10.1016/j.jdin.2020.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2020] [Indexed: 11/05/2022] Open
Abstract
Background Hidradenitis suppurativa (HS) demonstrates high placebo response rates in clinical trials, possibly due to the natural variability of the disease. No quantification of variability in lesion counts of untreated disease has been undertaken. Objective To quantify the variability of untreated HS. Methods Deidentified individual patient data from the placebo arms of PIONEER studies were analyzed, and measurements of within-subject coefficients of variation were examined. Variability was stratified by disease-associated variables (Hurley stage, BMI, sex, smoking, family history) and body site. Results Analysis of within-subject coefficients of variation demonstrated that half of the participants had a middle spread [difference between 75th and 25th percentiles of the subject's abscess and nodule counts] greater than 33% and 40% of their median abscess and nodule counts, and 25% of the subjects had a middle spread greater than 70% and 78% of their median abscess and nodule counts in PIONEER I and II, respectively. Hurley stage 2 participants had significantly greater within-subject variation than Hurley stage 3 patients. Variation was greater in the axillary and groin regions than in other anatomical locations. Limitations Limitations include the use of precollected clinical trial data. Conclusion The within-subject variability of the lesion counts in untreated HS was greater than previously appreciated. This has profound effects on outcome measures and the conduct of future clinical trials of HS.
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Affiliation(s)
- John W Frew
- Laboratory of Investigative Dermatology, Rockefeller University, New York, New York
| | - Caroline S Jiang
- Department of Biostatistics, Rockefeller University, New York, New York
| | - Neha Singh
- Department of Biostatistics, Rockefeller University, New York, New York
| | - Kristina Navrazhina
- Weill Cornell/Rockefeller/Sloan Kettering Tri-Institutional MD-PhD Program, Weill Cornell, New York, New York
| | - Roger Vaughan
- Department of Biostatistics, Rockefeller University, New York, New York
| | - James G Krueger
- Laboratory of Investigative Dermatology, Rockefeller University, New York, New York
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Gulliver W, Alavi A, Wiseman MC, Gooderham MJ, Rao J, Alam MS, Papp KA, Desjardins O, Jean C. Real-world effectiveness of adalimumab in patients with moderate-to-severe hidradenitis suppurativa: the 1-year SOLACE study. J Eur Acad Dermatol Venereol 2021; 35:2431-2439. [PMID: 34378812 PMCID: PMC9291024 DOI: 10.1111/jdv.17598] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 07/16/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND Long-term, real-word data are needed to help manage patients with hidradenitis suppurativa (HS) through this recurrent, painful and debilitating disease. OBJECTIVES To primarily measure real-world effectiveness of adalimumab in HS and to secondarily observe clinical course of HS in the light of patients' response. METHODS In SOLACE, adults with moderate-to-severe HS in need for change in ongoing therapy were treated with adalimumab for up to 52 weeks as per physician's medical practice. Treatment effectiveness was measured by Hidradenitis Suppurativa Clinical Response (HiSCR). Inflammatory nodules, abscesses and draining fistulas were counted, Hurley stage was assessed, and disease severity was rated using the International HS Severity Scoring System (IHS4). A post hoc analysis further explored the HiSCR response by abscess and inflammatory nodule (AN) count at baseline (low, medium and high) and gender. Spontaneously reported safety events were collected. RESULTS From 23 Canadian centres, 69% of the 138 patients achieved HiSCR at week 24, which increased to 82% and 75% at week 52 in patients with medium and high AN counts, respectively. Gender (4 times the odds for female) and age at HS onset (5% decrease with each additional year) had an effect on achieving HiSCR. Treatment with adalimumab led to an important decrease in number of lesions in responders, with most gains observed in inflammatory nodules, more frequently in the lower body area of patients in the high AN count group. The IHS4 scores of responders were substantially lowered, with a larger decrease in patients of the high AN count group. No new safety signal was detected. CONCLUSIONS The effectiveness of adalimumab was maintained during this 1-year period, and an optimal gain was documented for patients with medium and high AN counts. These real-world data support a prompt treatment of HS patients and the use of IHS4 to monitor treatment.
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Affiliation(s)
- W Gulliver
- NewLab Clinical Research Inc., St. John's, NL, Canada.,Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - A Alavi
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.,Probity Medical Research Inc., Waterloo, ON, Canada
| | - M C Wiseman
- Probity Medical Research Inc., Waterloo, ON, Canada.,Wiseman Dermatology Research, Winnipeg, MB, Canada.,Section of Dermatology, Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - M J Gooderham
- Probity Medical Research Inc., Waterloo, ON, Canada.,SKiN Centre for Dermatology, Peterborough, ON, Canada
| | - J Rao
- Clinical Professor of Medicine, Division of Dermatology, University of Alberta, Edmonton, AB, Canada
| | - M S Alam
- Probity Medical Research Inc., Waterloo, ON, Canada.,SimcoMed Health Ltd, Barrie, ON, Canada
| | - K A Papp
- Probity Medical Research Inc., Waterloo, ON, Canada.,Kim Papp Clinical Research, Waterloo, ON, Canada
| | | | - C Jean
- AbbVie Corporation, Saint-Laurent, QC, Canada
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35
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Kashetsky N, Mufti A, Alabdulrazzaq S, Lytvyn Y, Sachdeva M, Rahat A, Yeung J. Treatment Outcomes of IL-17 Inhibitors in Hidradenitis Suppurativa: A Systematic Review. J Cutan Med Surg 2021; 26:79-86. [PMID: 34365863 DOI: 10.1177/12034754211035667] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The IL-17 pathway is a potential therapeutic target shown to be implicated in hidradenitis suppurativa (HS), however, it remains unclear whether evidence from mechanistic studies may translate into clinical practice. This systematic review summarizes available treatment outcomes of IL-17 inhibitors in patients with HS. Embase, MEDLINE, PubMed, and clinicaltrials.gov were comprehensively searched on February 26, 2021 to include 16 original studies representing 128 patients with HS (mean age: 36.5 years; age range: 21-47 years; male: 50.0%). Treatment outcomes were reported for the following biologics: secukinumab (n = 105), brodalumab (n = 22), and ixekizumab (n = 1). Patients were classified as responders or non-responders according to achievement of a positive response/improvement based on criteria established for each included study. For secukinumab 57.1% (n = 60/105) of patients were responders in a mean response period of 16.2 weeks and 42.9% (n = 45/105) were non-responders; for brodalumab, 100.0% (n = 22/22) of patients were responders within 4.4 weeks; and the one patient treated with ixekizumab was a responder within 10 weeks. In conclusion, IL-17 inhibitors may serve as an effective therapeutic target in approximately two-thirds of patients with HS and can be considered in those who are refractory to other treatment modalities. We also stress the importance of consistent outcome measures to enhance evidence synthesis, decrease reporting bias, provide potential for future meta-analysis, and ultimately improve clinical outcomes for patients with HS.
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Affiliation(s)
- Nadia Kashetsky
- 7512 Faculty of Medicine, Memorial University of Newfoundland, St. John's, Canada
| | - Asfandyar Mufti
- 7938 Division of Dermatology, University of Toronto, Toronto, ON, Canada
| | | | - Yuliya Lytvyn
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | | | - Jensen Yeung
- 7938 Division of Dermatology, University of Toronto, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Probity Medical Research, Waterloo, ON, Canada
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36
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Clinical Implementation of Biologics and Small Molecules in the Treatment of Hidradenitis Suppurativa. Drugs 2021; 81:1397-1410. [PMID: 34283386 PMCID: PMC8352818 DOI: 10.1007/s40265-021-01566-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 01/03/2023]
Abstract
Hidradenitis suppurativa (HS) is a chronic, recurrent, auto-inflammatory skin disease originating from the hair follicles. The typical inflammatory nodules, abscesses, and draining sinus tracts (tunnels) are characterized by a massive influx of neutrophils, macrophages, B-cells, plasma cells, T helper (Th)1, Th17 cells and upregulation of pro-inflammatory cytokines such as IL-1, IL-17, IL-12/23, and TNF-α. Over the last decades, several clinical trials evaluated the clinical efficacy of different biologics targeting these pro-inflammatory cytokines, in particular TNF-α and IL-1. However, adalimumab is still the only registered drug for HS. This review discusses biologics and small molecules with high level of evidence for their clinical application, provides guidance on when and how to use these biologics and small molecules in clinical practice, and elaborates on the combination with medical and surgical treatment options beyond the current guidelines. Furthermore this review provides an overview of potential biologics and small molecules currently under investigation for novel targets in HS such as IL-36, C5a, Janus kinase family members, CD-40, LTA4 and CXCR1/2.
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Lee EH, Lee SH, Sohng C, Kim JY, Park KD, Lee SJ, Lee WJ. Extensive Nevus Comedonicus with Inflammatory Nodules and Cysts Controlled with Adalimumab. Ann Dermatol 2021; 33:361-364. [PMID: 34341638 PMCID: PMC8273314 DOI: 10.5021/ad.2021.33.4.361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 02/10/2020] [Accepted: 02/25/2020] [Indexed: 11/08/2022] Open
Abstract
Nevus comedonicus is a very rare skin disorder characterized by the presence of comedo-like dilated pores with keratinous plugs, rarely resulting in painful recurrent inflammatory nodules or cysts. It presents as localized or extensive form. It displays unilaterally or bilaterally segmental distribution. Histopathologically, it is characterized by keratin-filled epidermal invagination with bulbous proliferation of keratinocytes. The condition may be caused by fibroblast growth factor receptor 2 mutation. Although it may be controlled by a variety of therapeutic modalities, it is difficult to achieve complete resolution. We report a case of extensive nevus comedonicus with inflammatory nodules and cysts controlled with adalimumab.
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Affiliation(s)
- Eun Hye Lee
- Department of Dermatology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Seon Hwa Lee
- Department of Dermatology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Chihyeon Sohng
- Department of Dermatology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jun Young Kim
- Department of Dermatology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Kyung Duck Park
- Department of Dermatology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Seok-Jong Lee
- Department of Dermatology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Weon Ju Lee
- Department of Dermatology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
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Frew JW, Singh N, Jiang CS, Vaughan R, Krueger JG. The Impact of Body Mass Index Upon the Efficacy of Adalimumab in Hidradenitis Suppurativa. Front Med (Lausanne) 2021; 8:603281. [PMID: 34239882 PMCID: PMC8257943 DOI: 10.3389/fmed.2021.603281] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 05/13/2021] [Indexed: 11/16/2022] Open
Abstract
Elevated BMI in Hidradenitis Suppurativa is associated with decreased response to Adalimumab therapy. BMI is proposed to segregate distinct disease subtypes. It remains unresolved whether a threshold BMI exists above which increased dosages may provide clinical benefit. Individual patient data from 578 PIONEER Phase 3 participants were analyzed. Descriptive, multivariable regression analysis and receiver operating characteristic (ROC) curves were calculated to assess the relationship between BMI and clinical outcome measures using R v3.5.3. Participants in the overweight and obese BMI category had reduced odds (58 and 67%, respectively) of achieving HiSCR [OR = 0.42 (95%CI -0.19, 0.91) p = 0.03], [OR = 0.33 (95%CI 0.16, 0.67) p = 0.002] compared to participants with BMI < 25. Reduction in AN count and IHS4 score was not significantly associated. ROC analysis did not reveal any cut off value predictive of treatment outcome. No correlation between BMI and baseline disease activity or covariate interactions were identified. These findings suggest BMI is a significant covariate in the setting of lower baseline disease activity, supporting the concept of disease heterogeneity and differential therapeutic response to Adalimumab.
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Affiliation(s)
- John W. Frew
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, United States
| | - N. Singh
- Department of Biostatistics, The Rockefeller University, New York, NY, United States
| | - C. S. Jiang
- Department of Biostatistics, The Rockefeller University, New York, NY, United States
| | - R. Vaughan
- Department of Biostatistics, The Rockefeller University, New York, NY, United States
| | - J. G. Krueger
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, United States
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Melendez-Gonzalez MDM, Hamad J, Sayed C. Golimumab for the Treatment of Hidradenitis Suppurativa in Patients with Previous TNF-α Treatment Failure. J Invest Dermatol 2021; 141:2975-2979. [PMID: 34097922 DOI: 10.1016/j.jid.2021.04.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 04/06/2021] [Accepted: 04/08/2021] [Indexed: 10/21/2022]
Affiliation(s)
| | - Judy Hamad
- UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Christopher Sayed
- Department of Dermatology, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
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Lu JW, Huang YW, Chen TL. Efficacy and safety of adalimumab in hidradenitis suppurativa: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2021; 100:e26190. [PMID: 34087885 PMCID: PMC8183777 DOI: 10.1097/md.0000000000026190] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 05/14/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Adalimumab is used as a first-line biologic agent in the management of moderate-to-severe hidradenitis suppurativa (HS). The objective of the present study was to evaluate the efficacy and safety of adalimumab in patients with moderate-to-severe HS. METHODS We performed a systematic review and meta-analysis according to Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines. Pooled estimates, namely standardized mean difference (SMD) and relative risk (RR), were calculated using random-effect model with trial sequential analysis. Small study effects were examined using the Doi plot. Certainty of evidence (CoE) was assessed using "The Grading of Recommendations Assessment, Development, and Evaluation" approach, and number-needed-to-treat (NNT) was calculated. RESULTS Five randomized controlled trials, involving 1014 patients, were included. We performed subgroup analysis of adalimumab administered subcutaneously both weekly and every other week. Adalimumab administered weekly was associated with better clinical response achievement (RR 1.76, 95% confidence interval [95% CI] 1.35-2.29; trial sequential analysis TSA-adjusted CI 1.01-3.08; CoE: low; NNT = 5) and a significant improvement in modified Sartorius score (SMD = -0.45, 95% CI = -0.76 to -0.13; CoE: very low; NNT = 10) and dermatology life quality index (DLQI) (SMD -0.47, 95% CI -0.61 to -0.32; CoE: low; NNT = 10). Nevertheless, adalimumab administered every other week showed an improvement only in modified Sartorius score. The pooled RRs of adverse events in both groups revealed no statistical significance when compared with the placebo. CONCLUSIONS Adalimumab administered weekly resulted in not only better clinical responses than placebo but also significantly improved disease severity and quality of life of patients with moderate-to-severe HS. Our study provides supporting evidence to the current guidelines and aids decision-making in the application of adalimumab in HS management.
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Affiliation(s)
- Jing-Wun Lu
- Department of Medical Education, Hualien Tzu Chi Hospital, Hualien
| | - Yu-Wen Huang
- Department of Medical Education, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City
| | - Tai-Li Chen
- Department of Medical Education, Hualien Tzu Chi Hospital, Hualien
- School of Medicine, Tzu Chi University, Hualien, Taiwan
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Holcomb ZE, Porter ML, Kimball AB. A safety review of biologic therapies for the management of hidradenitis suppurativa and unmet needs. Expert Opin Drug Saf 2021; 20:1147-1161. [PMID: 33910441 DOI: 10.1080/14740338.2021.1924147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Hidradenitis suppurativa (HS) is a chronic, debilitating inflammatory skin disorder characterized by nodules, abscesses, fistulae, and significant scarring in intertriginous areas rich in apocrine glands. Immunomodulator drugs, including biologics, are a mainstay of treatment for this disease. AREAS COVERED This review details the safety profiles of various biologic therapies currently available commercially that have been tried for HS as assessed in clinical trials and observational studies. As the only Food and Drug Administration (FDA)-approved medication for the treatment of moderate-to-severe HS, adalimumab is discussed in the most detail. Additional biologic medications, including tumor necrosis factor α (TNFα) inhibitors, interleukin 1 (IL-1) inhibitors, IL-12 and IL-23 inhibitors, IL-17 inhibitors, and IL-23 inhibitors, are discussed as well. Safety concerns in special populations, including pregnant women and children, are outlined. EXPERT OPINION Existing data support excellent short-term and long-term safety profiles for adalimumab, although caution must be taken with use in high-risk patient populations, including those with chronic infections or increased risk of malignancy. Based on their safety data for other indications, additional biologic agents appear safe in HS as well. However, further research is needed to fully understand the safety profiles of these medications in the HS population.
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Affiliation(s)
- Zachary E Holcomb
- Department of Dermatology, Massachusetts General Hospital, Harvard Combined Dermatology Residency Program, Boston, MA, USA
| | - Martina L Porter
- Clinical Laboratory for Epidemiology and Applied Research in Skin (CLEARS), Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Dermatology, Harvard Medical School, Boston, MA, USA
| | - Alexa B Kimball
- Clinical Laboratory for Epidemiology and Applied Research in Skin (CLEARS), Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Dermatology, Harvard Medical School, Boston, MA, USA
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Odorici G, Pacetti L, Forconi R, Schettini N, Zedde P, Corazza M, Bettoli V. Seven Years-Experience of adalimumab therapy for hidradenitis suppurativa in a real-life dermatologic setting. J DERMATOL TREAT 2021; 33:2063-2067. [PMID: 33843413 DOI: 10.1080/09546634.2021.1914309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Hidradenitis Suppurativa (HS) often causes severe impairment of the quality of life of patients affected, as it is characterized by recurrent relapses of inflammation and predisposes to retractive scars, with severe alteration of anatomy of the affected regions. Adalimumab is currently the only approved long-term biological therapy for this disease. MATERIAL AND METHOD we retrospectively review the data of HS patients treated with Adalimumab at the "Hidradenitis Suppurativa Clinic", University of Ferrara, Italy since the drug was first available to October 2020. The aim is to describe our real-life experience in a clinical outpatient service. We assessed the main demographic features, therapy duration, reasons of suspension and efficacy (evaluated by HiSCR - Hidradenitis Score) in relation to surgical procedures, hospitalization, number of areas involved by the disease and BMI >30. We also assessed the aspects related to the use of adalimumab's biosimilar. RESULTS data on 76 patients, with a mean age of 38.26 ± 14.74 years and mean BMI 28.10 ± 5.92 were collected. Most of the treated patients had Hurley stage III (58/76); mean Sartorius score was 115.5 ± 55.86, mean IHS4 was 76.1 ± 44.3. A statistically significant correlation between hospitalization and cessation of adalimumab, the loss of the achievement of the HiSCR, and surgery was found. No need to do surgery was a protective factor against the failure of adalimumab treatment, meaning that the most severe cases are more likely to fail the biological therapy. CONCLUSION new scenarios are opening up in clinical practice: the arrival of biosimilars allow greater sustainability of expenditure, while the anti-IL17 allow the patient who has failed therapy with adalimumab a valid and safe therapeutic option to be undertaken. A comprehensive care including hospitalization, a specific antibiotic therapy and surgical treatment is often mandatory to achieve a satisfactory control of the disease.
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Affiliation(s)
- G Odorici
- Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, Ferrara, Italy
| | - L Pacetti
- Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, Ferrara, Italy
| | - R Forconi
- Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, Ferrara, Italy
| | - N Schettini
- Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, Ferrara, Italy
| | - P Zedde
- Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, Ferrara, Italy
| | - M Corazza
- Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, Ferrara, Italy
| | - V Bettoli
- Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, Ferrara, Italy
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Frew JW, Lowes MA, Goldfarb N, Butt M, Piguet V, O'Brien E, Ingram J, Jemec GBE, Tan J, Zouboulis C, Alavi A, Kirby JS. Global Harmonization of Morphological Definitions in Hidradenitis Suppurativa for a Proposed Glossary. JAMA Dermatol 2021; 157:449-455. [PMID: 33688910 PMCID: PMC10448246 DOI: 10.1001/jamadermatol.2020.5467] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance Standard morphological terminology and definitions are vital for identification of lesion types in the clinical trial setting and communication about the condition. For hidradenitis suppurativa (HS), morphological definitions have been proposed by different groups, representing various regions of the world, but no international consensus has been reached regarding such definitions. A lack of globally harmonized terminology and definitions may contribute to poor-quality data collection in clinical trials as well as poor communication among clinicians, investigators, and patients. Objective To establish and validate consensus definitions for typical morphological findings for HS lesions. Methods This study was conducted from August 2019 to August 2020. A Delphi study technique was used to assess agreement and then resolve disagreement on HS terminology among international experts. After an initial preparation phase, the process consisted of 3 rounds. In each round, participants reviewed preliminary definitions and rated them as "keep, with no changes," "keep, with changes," or "remove." Eight HS primary lesions, including papule, pustule, nodule, plaque, ulcer, abscess, comedo, and tunnel, were selected because they are most frequently used in HS clinician-reported outcome measures. The initial definitions were based on extant literature, and modifications were made between rounds based on qualitative thematic analysis of open-ended responses or discussion. Consensus was defined as greater than 70% to accept a definition. Consensus stability across rounds was defined as less than 15% change in agreement. Reliability was evaluated using the Gwet agreement coefficient. Validation was based on assessment of face validity and stability across rounds. Results A total of 31 experts participated. All 8 HS primary lesion definitions achieved greater than 70% consensus by Delphi round 3. Stability was achieved for papule, pustule, and abscess. The Gwet agreement coefficient increased from 0.49 (95% CI, 0.26-0.71) in round 1 to 0.78 (95% CI, 0.64-0.92) in round 3. Face validity was supported by expert endorsement to keep terms in survey responses. Previously unmeasured variation among clinicians' definition of tunnels was identified, and consensus was achieved. Conclusions and Relevance An international group of experts agreed on definitions for morphological features of HS lesions frequently included in HS clinical trials. These international consensus terms and definitions are needed to support consistency of lesion identification and quantification in clinical trials.
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Affiliation(s)
- John W Frew
- Laboratory of Investigative Dermatology, The Rockefeller University, New York City, New York
| | | | - Noah Goldfarb
- Department of Internal Medicine, University of Minnesota, Minneapolis
- Department of Dermatology, University of Minnesota, Minneapolis
- Department of Internal Medicine, Minneapolis VA Health Care System, Minneapolis, Minnesota
- Department of Dermatology, Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - Melissa Butt
- Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Vincent Piguet
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Dermatology, Women's College Hospital, Toronto, Ontario, Canada
| | - Elizabeth O'Brien
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Dermatology, Women's College Hospital, Toronto, Ontario, Canada
| | - John Ingram
- Department of Dermatology and Wound Healing, Division of Infection and Immunity, Cardiff University, Cardiff, United Kingdom
| | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Jerry Tan
- Department of Medicine, University of Western Ontario, Windsor, Ontario, Canada
| | - Christos Zouboulis
- Department of Dermatology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
- Department of Venereology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
- Departments of Allergology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
- Department of Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Joslyn S Kirby
- Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
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Frew JW, Jiang CS, Singh N, Grand D, Navrazhina K, Vaughan R, Krueger JG. Dermal tunnels influence time to clinical response and family history influences time to loss of clinical response in patients with hidradenitis suppurativa treated with adalimumab. Clin Exp Dermatol 2021; 46:306-313. [PMID: 32931599 DOI: 10.1111/ced.14448] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Clinical response in hidradenitis suppurativa (HS) is most commonly assessed using the Hidradenitis Suppurativa Clinical Response (HiSCR) measure. Dermal tunnels, increased body mass index, smoking and antibiotic use significantly decrease the odds of achieving HiSCR. However, there are few data exploring if clinical features are also associated with length of time to achieve clinical response and/or time to lose clinical response. AIM To explore whether variables associated with achievement of HiSCR are associated with time to achieve HiSCR and time to loss of HiSCR in patients with HS treated with adalimumab 40 mg weekly in the PIONEER open-label extension study. METHODS Time-to-event analyses were performed to estimate time to achieve HiSCR and time to loss of HiSCR. The log rank test was used to compare cumulative incidence curves for a priori patient- and disease-associated factors. Cox regression analysis was performed to compare time-to-event outcomes in the presence of a priori variables. All statistical analyses were completed with R software (V3.5.3). RESULTS Presence of dermal tunnels significantly increased the time to achieve HiSCR (median 32.6 vs. 14.3 weeks, P = 0.02) and the hazard ratio (HR) was significant after controlling for patient and disease factors (HR = 0.70, 95% CI 0.51-0.96, P = 0.03). A positive family history of HS significantly decreased the time to loss of HiSCR (median 11.4 vs. 18 weeks, P < 0.001) and remained significant in Cox regression analysis (HR = 2.01, 95% CI 1.40-2.88, P < 0.001). CONCLUSION The presence of dermal tunnels significantly influences the odds of achieving HiSCR and the time to achieve HiSCR, while family history influences time to loss of HiSCR.
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Affiliation(s)
- J W Frew
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, USA
| | - C S Jiang
- Department of Biostatistics, The Rockefeller University, New York, NY, USA
| | - N Singh
- Department of Biostatistics, The Rockefeller University, New York, NY, USA
| | - D Grand
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, USA
- Albert Einstein College of Medicine, Bronx, New York, NY, USA
| | - K Navrazhina
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, USA
- Weill Cornell/Rockefeller/Sloan Kettering Tri-Institutional MD-PhD Program, Weill Cornell University, New York, NY, USA
| | - R Vaughan
- Department of Biostatistics, The Rockefeller University, New York, NY, USA
| | - J G Krueger
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, USA
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Is There a Role for Therapeutic Drug Monitoring in Patients with Hidradenitis Suppurativa on Tumor Necrosis Factor-α Inhibitors? Am J Clin Dermatol 2021; 22:139-147. [PMID: 33398848 DOI: 10.1007/s40257-020-00579-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Tumor necrosis factor-α inhibitors, adalimumab and infliximab, are at the forefront of biologic therapy for the management of moderate-to-severe hidradenitis suppurativa, with adalimumab as currently the only approved medication for this condition. In treating patients, primary or secondary lack of response (also termed suboptimal response) is a major burden for both patients and healthcare systems and is a challenge with biologics in part owing to the development of anti-drug antibodies following treatment. To overcome this, therapeutic drug monitoring may be conducted proactively or reactively to a patient's suboptimal response guided by measurements of trough serum drug concentrations and levels of anti-drug antibodies. While strong evidence to support the utility of therapeutic drug monitoring exists in patients with inflammatory bowel disease, current information is limited in the context of hidradenitis suppurativa. We sought to summarize the available evidence and to present the role of therapeutic drug monitoring and other dose optimization strategies in improving clinical response in patients with hidradenitis suppurativa treated with tumor necrosis factor-α inhibitors.
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Abdalla T, Mansour M, Bouazzi D, Lowes MA, Jemec GBE, Alavi A. Therapeutic Drug Monitoring in Patients with Suboptimal Response to Adalimumab for Hidradenitis Suppurativa: A Retrospective Case Series. Am J Clin Dermatol 2021; 22:275-283. [PMID: 33242185 DOI: 10.1007/s40257-020-00575-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Adalimumab, a tumor necrosis factor-α inhibitor, is a biologic used for the treatment of moderate-to-severe hidradenitis suppurativa (HS). It is well known that patients may experience loss of efficacy from its use in other conditions, and it is suggested that developing a strategy for therapeutic drug monitoring (TDM) may help secure optimal clinical outcomes. OBJECTIVES We sought to determine serum adalimumab concentrations and anti-adalimumab antibody (AAA) status in patients with moderate-to-severe HS. METHODS A retrospective case series of 38 patients with suboptimal response to adalimumab 40 mg weekly was conducted at a community dermatology clinic. Adalimumab serum trough levels, AAA status, and inflammatory biomarkers were collected. Blood was drawn on identification of suboptimal response (after a minimum of 12 weeks) and was collected once prior to receiving the next scheduled dose. Kruskal-Wallis and Chi-squared tests were used for data analysis. RESULTS A total of 38 patients had a median adalimumab trough concentration of 8.76 (interquartile range [IQR] 1.3-12.5) µg/mL. The median duration of adalimumab therapy of all patients was 21 (IQR 12-24) months. AAAs were detected in nine patients (24%), and all had subtherapeutic serum concentrations (< 6 µg/mL). Patients who were AAA+ had a significantly lower median adalimumab concentration than those who were AAA- (0.02 µg/mL [range 0.02-0.81] vs. 10.14 [range 0.76-48.00]; p = 0.0006). CONCLUSION Patients with AAAs had significantly lower serum adalimumab levels. The current study suggests that TDM may identify underlying reasons for suboptimal response and detect patients who may benefit from dose optimization strategies.
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Affiliation(s)
- Tasnim Abdalla
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Mark Mansour
- Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Dorra Bouazzi
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
- Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | | | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
- Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - Afsaneh Alavi
- Faculty of Medicine, University of Toronto, Toronto, Canada.
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.
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Sanchez-Diaz M, Martinez-Lopez A, Salvador-Rodriguez L, Montero-Vilchez T, Arias-Santiago S, Molina-Leyva A. The role of biologic treatment in special scenarios in hidradenitis suppurativa: Facial and nape phenotype, dissecting cellulitis of the scalp, and lymphedema. Dermatol Ther 2021; 34:e14829. [PMID: 33527618 DOI: 10.1111/dth.14829] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 01/21/2021] [Accepted: 01/23/2021] [Indexed: 11/29/2022]
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory disorder affecting the hair follicle which typically affects the axilla, inguinal, submammary, and perianal areas. Atypical HS, such as facial HS, dissecting cellulitis of the scalp (DCS), nape HS, and HS lymphedema has also been described. There is scarce evidence about the treatment of atypical HS. To describe the efficacy of biologic drugs and adjuvant therapeutic interventions used in patients with atypical HS who had an inadequate response to systemic antibiotics. Prospective case series study of patients with atypical HS (facial HS, DCS, nape HS, and HS lymphedema) treated with biologic drugs in a HS Clinic setting. Disease activity indexes, sociodemographic, clinical, and safety variables were collected. Two patients met criteria for Facial HS, three met criteria for DCS/nape HS and three patients met criteria for HS lymphedema. Patients with facial HS achieved rapid improvement without requiring other therapies. Patients with DCS, nape HS, and HS lymphedema showed variable response, with decrease of activity indexes, and requiring adjuvant treatments. Biologic drugs are useful in the management of special HS locations. In the case of facial HS, biologic therapy seems to be quite effective as monotherapy. In the cases of DCS, HS lymphedema and nape HS, treatment combination or intensification may be needed.
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Affiliation(s)
- Manuel Sanchez-Diaz
- Hidradenitis Suppurativa Clinic, Department of Dermatology, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Antonio Martinez-Lopez
- Hidradenitis Suppurativa Clinic, Department of Dermatology, Hospital Universitario Virgen de las Nieves, Granada, Spain.,European Hidradenitis Suppurativa Foundation (EHSF), Dessau-Roßlau, Germany
| | - Luis Salvador-Rodriguez
- Hidradenitis Suppurativa Clinic, Department of Dermatology, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Trinidad Montero-Vilchez
- Hidradenitis Suppurativa Clinic, Department of Dermatology, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Salvador Arias-Santiago
- Hidradenitis Suppurativa Clinic, Department of Dermatology, Hospital Universitario Virgen de las Nieves, Granada, Spain.,European Hidradenitis Suppurativa Foundation (EHSF), Dessau-Roßlau, Germany
| | - Alejandro Molina-Leyva
- Hidradenitis Suppurativa Clinic, Department of Dermatology, Hospital Universitario Virgen de las Nieves, Granada, Spain.,European Hidradenitis Suppurativa Foundation (EHSF), Dessau-Roßlau, Germany.,Instituto de Investigación Biosanitaria, Granada, Spain
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48
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Condamina M, Penso L, Tran VT, Hotz C, Guillem P, Villani AP, Perrot P, Bru MF, Jacquet E, Nassif A, Bachelez H, Wolkenstein P, Beylot-Barry M, Richard MA, Ravaud P, Viguier M, Sbidian E. Baseline Characteristics of a National French E-Cohort of Hidradenitis Suppurativa in ComPaRe and Comparison with Other Large Hidradenitis Suppurativa Cohorts. Dermatology 2021; 237:748-758. [PMID: 33503635 DOI: 10.1159/000513447] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/29/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition substantially impacting patients' quality of life; the pathogenesis remains unclear, and treatment is complex and not yet standardized. Observational data are increasingly being used to evaluate therapeutics in "real-life" interventions, and the development of e-cohorts is offering new tools for epidemiological studies at the population level. OBJECTIVE The aim of this study was to describe the clinical characteristics and treatment history of HS participants in the Community of Patients for Research (ComPaRe) cohort and to compare these to other cohorts. METHODS We performed a cross-sectional study of the baseline data of HS participants in ComPaRe, an e-cohort of patients with chronic diseases. Data were collected using patient-reported questionnaires about clinical-dem-ographic aspects, quality of life, and treatment history. RESULTS A total of 396 participants (339 females, 57 males) were included (mean age 38 years); 83 (21%) had a family history of HS, 227 (57.3%) were current smokers, and 241 (60.9%) were overweight or obese. Most of the participants declared a Hurley stage II (n = 263, 66.4%) or III (n = 76, 20.3%). The breast was more frequently affected in women than men (37.5 vs. 5.3%, p < 0.0001), whereas the dorsal region was more frequently affected in men (39.5 vs. 10.9%, p < 0.0001). Increased disease stage was associated with obesity (25.9 vs. 33.8 vs. 51.3%, p = 0.02) and some HS localizations (genital [p < 0.005], pubis [p < 0.007], gluteal fold [p = 0.02], and groin [p < 0.0001]). The most frequently prescribed treatments were oral antibiotics (n = 362, 91.4%), especially amoxicillin-clavulanic acid and cyclins. Less than 10% of participants received biologics. Most of these results were consistent with previously published cohorts. CONCLUSION Recruitment of participants by such a web platform can be a faster way to get relevant scientific data for a wide variety of patients that could be used for epidemiological studies and to evaluate therapeutics in "real-life" interventions.
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Affiliation(s)
- Morgane Condamina
- Department of Dermatology-Venereology, Robert-Debré Hospital, Reims, France
| | - Laetitia Penso
- Paris-Est University, UPEC, EA 7379 EpiDermE (Epidemiologie En Dermatologie et Evaluation des Thérapeutiques), Créteil, France
| | - Viet-Thi Tran
- Center for Clinical Epidemiology, Hôtel-Dieu Hospital (AP-HP), Paris, France.,Centre de Recherche Épidémiologie et StatistiqueS (CRESS), Université de Paris, INSERM UMR1153, Paris, France
| | - Claire Hotz
- Department of Dermatology-Venereology, Henri Mondor Hospital (AP-HP), Paris Est Créteil University, Créteil, France
| | - Philippe Guillem
- Department of Visceral and Digestive Surgery, Val d'Ouest Clinic, Écully, France.,RésoVerneuil, Paris, France.,European Hidradenitis Suppurativa Foundation, Dessau, Germany.,Groupe de Recherche en Proctologie de la Société Nationale Française de Coloproctologie, Paris, France
| | | | - Pierre Perrot
- Department of Plastic and Reconstructive Surgery, Hôtel-Dieu Hospital, Nantes, France
| | - Marie-France Bru
- Patient Member of the Scientific Committee of ComPaRe Verneuil Disease, Paris, France
| | - Eric Jacquet
- Department of Visceral Surgery, Beau Soleil Clinic, Montpellier, France
| | - Aude Nassif
- Medical Center, Institut Pasteur, Paris, France
| | - Hervé Bachelez
- Department of Dermatology-Venereology, Saint Louis Hospital (AP-HP), Sorbonne Paris Cité University Paris Diderot, Paris, France.,Laboratory of Genetics of Skin Diseases, INSERM U1163, Imagine Institute, Paris, France
| | - Pierre Wolkenstein
- Paris-Est University, UPEC, EA 7379 EpiDermE (Epidemiologie En Dermatologie et Evaluation des Thérapeutiques), Créteil, France.,Department of Dermatology-Venereology, Henri Mondor Hospital (AP-HP), Paris Est Créteil University, Créteil, France
| | - Marie Beylot-Barry
- Department of Dermatology, INSERM 1053, CHU Bordeaux, Bordeaux University, Bordeaux, France
| | - Marie-Aleth Richard
- CEReSS-EA 3279, Research Center in Health Services and Quality of Life, Aix Marseille University, Dermatology Department, University Hospital La Timone, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Philippe Ravaud
- Center for Clinical Epidemiology, Hôtel-Dieu Hospital (AP-HP), Paris, France.,Centre de Recherche Épidémiologie et StatistiqueS (CRESS), Université de Paris, INSERM UMR1153, Paris, France
| | - Manuelle Viguier
- Department of Dermatology-Venereology, Robert-Debré Hospital, Reims, France
| | - Emilie Sbidian
- Paris-Est University, UPEC, EA 7379 EpiDermE (Epidemiologie En Dermatologie et Evaluation des Thérapeutiques), Créteil, France, .,Department of Dermatology-Venereology, Henri Mondor Hospital (AP-HP), Paris Est Créteil University, Créteil, France, .,INSERM, Centre d'Investigation Clinique 1430, Créteil, France,
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49
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González-Manso A, Agut-Busquet E, Romaní J, Vilarrasa E, Bittencourt F, Mensa A, Cantó E, Aróstegui JI, Vidal S. Hidradenitis Suppurativa: Proposal of Classification in Two Endotypes with Two-Step Cluster Analysis. Dermatology 2020; 237:365-371. [PMID: 33171462 DOI: 10.1159/000511045] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/19/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Hidradenitis suppurativa (HS) is a chronic, inflammatory, recurrent disorder of the pilosebaceous unit. Currently, several attempts have been made to classify this disease according to its pathogenesis and clinical manifestations. We attempted at classifying 103 patients using two-step cluster analysis. METHODS The final model included body mass index, C-reactive protein (CRP), and serum concentrations of IL-1, IL-6, IL-17, and IL-10 as continuous variables, and sex, later/early onset, anterior/posterior lesion sites, presence/absence of sinus tracts, nodules and abscesses, positive/negative history of pilonidal sinus, and presence/absence of mutations in gamma-secretase subunits (APH1A, APH1B, MEFV, NCSTN, PSEN1, PSEN2, PSENEN, PSTPIP1) as qualitative variables. RESULTS The resultant model defined two groupings or clusters: cluster 1 (64.9% of patients) characterized by nonobese males, with nodular lesions in posterior sites, early-onset HS, higher IL-10, presence of gamma-secretase mutations, and history of pilonidal sinus; and cluster 2 (35.1% of patients) characterized by obese females or males, with lesions in anterior sites, more presence of sinus tracts and abscesses and less nodules, later-onset HS, and higher concentrations of IL-1, CRP, IL-17, and IL-6. Severity measures (Hurley, HS-PGA, and IHS4) and tobacco use were discarded because the analysis found them to be less relevant for clustering. CONCLUSION Our resultant model confirms the clinical impression that HS is a disease spectrum with two pathogenic poles defining two clusters or endotypes. The probability of having severe disease was equally distributed in the two clusters. The variable with the highest predictive value for clustering was involvement of typical anterior sites (axillae, submammary) or atypical posterior sites (back, gluteal). Serum concentrations of interleukins, tobacco use, and sex had a lower predictive power for clustering.
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Affiliation(s)
- Anxo González-Manso
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Eugènia Agut-Busquet
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain.,Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jorge Romaní
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain, .,Department of Dermatology, Consorci Sanitari Parc Taulí, Sabadell, Spain,
| | - Eva Vilarrasa
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain.,Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Flavia Bittencourt
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain.,Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Anna Mensa
- Department of Immunology, Hospital Clínic i Provincial, Barcelona, Spain
| | - Elisabeth Cantó
- Department of Immunology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Juan I Aróstegui
- Department of Immunology, Hospital Clínic i Provincial, Barcelona, Spain
| | - Silvia Vidal
- Department of Immunology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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50
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Goldfarb N, Lowes MA, Butt M, King T, Alavi A, Kirby JS. Hidradenitis Suppurativa Area and Severity Index Revised (HASI-R): psychometric property assessment. Br J Dermatol 2020; 184:905-912. [PMID: 32969027 DOI: 10.1111/bjd.19565] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 08/09/2020] [Accepted: 09/21/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Validated, reliable, globally accepted outcome measurement instruments for hidradenitis suppurativa (HS) are needed. Current tools to measure the physical signs domain for HS rely on lesion counts, which are time-consuming and unreliable. OBJECTIVES To assess the reliability and validity of the Hidradenitis suppurativa Area and Severity Index Revised (HASI-R) tool, a novel method for assessing HS severity, incorporating signs of inflammation and body surface area involved. METHODS The measurement properties of the HASI-R tool were evaluated. The tool was created by combining the previously published HASI and Severity and Area Score for Hidradenitis instruments. Twenty raters evaluated 15 patients with HS in a hospital-based ambulatory dermatology clinic. The objectives of the study were to assess inter- and intra-rater reliability of the HASI-R and its components, as well as its construct and known-groups validity. Existing lesion count-based clinician-reported measures of HS and their components were also assessed. Raters were also asked their preferences regarding the various HS severity assessment tools. RESULTS The HASI-R had moderate inter-rater reliability [intra-class correlation coefficients (ICC) 0·60]. This was better than all other HS physical sign outcome measures evaluated, which had poor inter-rater reliability (ICC < 0·5). HASI-R had the highest intra-rater reliability (ICC 0·91). The HASI-R had good construct validity and demonstrated known-groups validity. The HASI-R was also the most preferred tool by all raters. CONCLUSIONS Results from the clinometric assessment of the HASI-R are encouraging, and support continued evaluation of this clinician-reported outcome measure.
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Affiliation(s)
- N Goldfarb
- Departments of Medicine and Dermatology, University of Minnesota, Minneapolis, MN, USA.,Departments of Medicine and Dermatology, Minneapolis Veteran Affairs Health Care System, Minneapolis, MN, USA
| | - M A Lowes
- The Rockefeller University, New York, NY, USA
| | - M Butt
- Department of Dermatology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - T King
- Department of Dermatology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - A Alavi
- Department of Medicine, Division of Dermatology, Women's College Hospital, University of Toronto, Toronto, Canada
| | - J S Kirby
- Department of Dermatology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
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