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Montero-Vilchez T, Salvador-Rodriguez L, Sanchez-Diaz M, Cuenca-Barrales C, Martinez-Lopez A, Arias-Santiago S, Molina-Leyva A. Clinical selection criteria in new clinical trials of hidradenitis suppurativa: External validity and implications on the daily clinical practice. Dermatol Ther 2020; 33:e14254. [PMID: 32860480 DOI: 10.1111/dth.14254] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/18/2020] [Accepted: 08/21/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION There are an increasing number of biologic drugs in the pipeline for treating hidradenitis suppurativa (HS). Clinical trials for these drugs usually share the same clinical selection criteria. OBJECTIVES (a) To describe the clinical profile of HS patients receiving first-line biologic treatment in an HS clinic setting, (b) to assess how this population would meet clinical criteria to participate in a clinical trial, and (c) to assess treatment effectiveness at week 16 in eligible vs non-eligible patients. METHODS Prospective observational study. Patients were grouped according to their eligibility for clinical trials. The effectiveness of adalimumab was assessed by HiSCR, IHS4-category-change and a-50%-reduction on IHS4 at week 16. RESULTS Thirty-eight patients were included in the study: eight (21.05%) were eligible for clinical trials and 30 (78.95%) were not. The main reason for non-eligibility was not having an AN count ≥5. Both groups presented similar number of draining tunnels. Effectiveness at week 16 was lower in non-eligible than eligible patients when evaluated by HiSCR-response but similar if evaluated by the IHS4-category-change or the 50%-reduction in IHS4. CONCLUSION In our population, the external validity of current eligibility criteria for clinical trials is low. Most patients receiving adalimumab in real-life setting would not be eligible for clinical trials.
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Affiliation(s)
- Trinidad Montero-Vilchez
- Department of Dermatology, Hidradenitis Suppurativa Clinic, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Instituto de Investigación Biosanitaria Granada, Granada, Spain
| | - Luis Salvador-Rodriguez
- Department of Dermatology, Hidradenitis Suppurativa Clinic, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Instituto de Investigación Biosanitaria Granada, Granada, Spain
| | - Manuel Sanchez-Diaz
- Department of Dermatology, Hidradenitis Suppurativa Clinic, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Instituto de Investigación Biosanitaria Granada, Granada, Spain
| | - Carlos Cuenca-Barrales
- Department of Dermatology, Hidradenitis Suppurativa Clinic, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Instituto de Investigación Biosanitaria Granada, Granada, Spain
| | - Antonio Martinez-Lopez
- Department of Dermatology, Hidradenitis Suppurativa Clinic, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Instituto de Investigación Biosanitaria Granada, Granada, Spain
| | - Salvador Arias-Santiago
- Department of Dermatology, Hidradenitis Suppurativa Clinic, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Instituto de Investigación Biosanitaria Granada, Granada, Spain.,Department of Medicine, Granada School of Medicine, Granada University, Granada, Spain
| | - Alejandro Molina-Leyva
- Department of Dermatology, Hidradenitis Suppurativa Clinic, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Instituto de Investigación Biosanitaria Granada, Granada, Spain.,European Hidradenitis Suppurativa Foundation, Dessau-Roßlau, Germany
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Bettuzzi T, Bachelez H. Reply to: Comment on "Sirolimus as combination rescue therapy with tumor necrosis alpha inhibitors for severe, refractory hidradenitis suppurativa". J Am Acad Dermatol 2020; 84:e267-e268. [PMID: 32800873 DOI: 10.1016/j.jaad.2020.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 08/10/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Thomas Bettuzzi
- Department of Dermatology, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris
| | - Hervé Bachelez
- Department of Dermatology, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris; Université de Paris; Laboratory of Genetics of Skin Diseases, Unité Mixte de Recherches Inserm U1163, Institut Imagine, Paris, France.
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53
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Kanni T, Argyropoulou M, Dinarello CA, Simard J, Giamarellos-Bourboulis EJ. MABp1 targeting interleukin-1α in hidradenitis suppurativa ineligible for adalimumab treatment: results of the open-label extension period. Clin Exp Dermatol 2020; 46:162-163. [PMID: 32516832 DOI: 10.1111/ced.14333] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2020] [Indexed: 02/06/2023]
Affiliation(s)
- T Kanni
- Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - M Argyropoulou
- Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - C A Dinarello
- Department of Medicine, The University of Colorado in Denver, Denver, CO, USA
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Zouboulis CC, Gulliver W, Ingram J, Kirby B, Giamarellos-Bourboulis EJ, Podda M, Tzellos T, Jemec GBE. Endpoints of clinical trials for Hidradenitis Suppurativa: Proceedings of a round-table session. Exp Dermatol 2020; 29 Suppl 1:67-72. [PMID: 32691939 DOI: 10.1111/exd.14123] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany
| | - Wayne Gulliver
- Memorial University of Newfoundland, St. John's, NL, Canada.,NewLab Clinical Research Inc, St. John's, NL, Canada
| | - John Ingram
- Division of Infection and Immunity, Department of Dermatology and Academic Wound Healing, Cardiff University, Cardiff, UK
| | - Brian Kirby
- St Vincent's University Hospital and Charles Institute, University College Dublin, Dublin, Ireland
| | | | | | | | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
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55
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Nguyen T, Damiani G, Orenstein L, Hamzavi I, Jemec G. Hidradenitis suppurativa: an update on epidemiology, phenotypes, diagnosis, pathogenesis, comorbidities and quality of life. J Eur Acad Dermatol Venereol 2020; 35:50-61. [DOI: 10.1111/jdv.16677] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 04/03/2020] [Indexed: 12/11/2022]
Affiliation(s)
- T.V. Nguyen
- Bellevue Dermatology Clinic & Clinical Research Center Bellevue WA USA
| | - G. Damiani
- Department of Dermatology Emory University School of Medicine Atlanta GA USA
| | - L.A.V. Orenstein
- Dipartimento di Fisiopatologia Medico‐Chirurgica e dei Trapianti Università degli Studi di Milano Unità Operativa di Dermatologia IRCCS Fondazione Ca' GrandaOspedale Maggiore Policlinico Milano Italy
| | - I. Hamzavi
- Department of Dermatology Henry Ford Hospital Detroit MI USA
| | - G.B. Jemec
- Department of Dermatology Zealand University Hospital Roskilde Denmark
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56
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Hidradenitis suppurativa. J Am Acad Dermatol 2020; 82:1045-1058. [DOI: 10.1016/j.jaad.2019.08.090] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 08/14/2019] [Accepted: 08/15/2019] [Indexed: 12/17/2022]
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57
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van der Zee H, Longcore M, Geng Z, Garg A. Weekly adalimumab treatment decreased disease flare in hidradenitis suppurativa over 36 weeks: integrated results from the phase 3 PIONEER trials. J Eur Acad Dermatol Venereol 2020; 34:1050-1056. [PMID: 31630445 PMCID: PMC7318582 DOI: 10.1111/jdv.16023] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 09/25/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic skin disease characterized by inflammatory lesions that flare unpredictably. The impact of weekly adalimumab (ADAew) on HS flare is not well-characterized. OBJECTIVE To evaluate the impact of disease flare on health-related quality of life (HRQOL) in moderate-to-severe HS patients and to determine the effect of ADAew on disease flare using integrated data from two phase 3 trials over 36 weeks. METHODS In period A (12 weeks), Dermatology Life Quality Index (DLQI) score change from baseline was compared in patients who flared and those who did not, regardless of treatment. The proportion of patients experiencing flare, duration of flare and time to flare was evaluated for ADAew vs. placebo (PBO). In period B (24 weeks), proportion of patients experiencing flare who received continuous ADAew treatment through 36 weeks was assessed. RESULTS HRQOL was markedly improved among those who did not experience flare. In period A, the proportion of patients who experienced flare was significantly lower with ADAew vs. PBO (12.3% vs. 35.3%, P < 0.001). ADAew patients also had longer time to first flare (101 days vs. 57 days; P < 0.001) and shorter flare duration (18.9 days vs. 32.0 days, respectively; P = 0.001) vs. PBO. Through 36 weeks of treatment, 20.2% of ADAew patients flared, and for those who achieved at least a partial clinical response to ADAew at 12 weeks, only 5.7% flared. CONCLUSIONS Flare reduction is an important measure in HS that correlates with clinically meaningful improvement in HRQOL. ADAew reduces HS flare through 12 and subsequent 36 weeks of treatment.
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Affiliation(s)
- H.H. van der Zee
- Department of DermatologyErasmus Medical CenterRotterdamThe Netherlands
| | | | - Z. Geng
- AbbVie IncNorth ChicagoILUSA
| | - A. Garg
- Department of DermatologyZucker School of Medicine at Hofstra/NorthwellNew Hyde ParkNYUSA
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58
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Daveluy S. Medical therapy is the optimal treatment for hidradenitis suppurativa. J Am Acad Dermatol 2020; 83:977-978. [PMID: 32171810 DOI: 10.1016/j.jaad.2020.02.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 02/06/2020] [Accepted: 02/10/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Steven Daveluy
- Department of Dermatology, Wayne State University, Detroit, Michigan.
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59
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Rosales Santillan M, Morss PC, Porter ML, Kimball AB. Biologic therapies for the treatment of hidradenitis suppurativa. Expert Opin Biol Ther 2020; 20:621-633. [PMID: 32077334 DOI: 10.1080/14712598.2020.1732918] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Introduction: Hidradenitis suppurativa (HS) is a chronic skin disorder characterized by inflammatory nodules, abscesses, and fistulae. Patients tend to present in young adulthood and are predominantly female. The pathogenesis of HS involves apopilosebaceous gland follicle occlusion and affected areas often occur where this type of gland predominates. Treatment selection depends on HS severity, which is included in different scoring systems. In recent years, biological therapies have been evaluated and used with increasing frequency in moderate-to-severe HS disease.Areas covered: This review focuses on biological therapies for HS as assessed in case reports, case series, and clinical trials. The efficacy, hidradenitis suppurativa scoring systems, and long-term results of these therapies are discussed depending on the studies' endpoints.Expert opinion: Adalimumab is currently the only FDA-approved HS biological therapy. Some patients do not experience treatment efficacy with adalimumab at 40 mg/week, which may result in increasing the dose or seeking other treatments. Infliximab is the next line of HS treatment with demonstrated efficacy. Other biological therapies being studied have demonstrated efficacy in small patient groups, but lack study power. Further studies may provide answers to seeking treatment options for patients who fail to improve on current standard HS treatment.
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Affiliation(s)
- Monica Rosales Santillan
- Harvard Medical School and Clinical Laboratory for Epidemiology and Applied Research in Skin (CLEARS), Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Peyton C Morss
- Harvard Medical School and Clinical Laboratory for Epidemiology and Applied Research in Skin (CLEARS), Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Medical School, University of Massachusetts, Worcester, MA, USA
| | - Martina L Porter
- Harvard Medical School and Clinical Laboratory for Epidemiology and Applied Research in Skin (CLEARS), Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Alexa B Kimball
- Harvard Medical School and Clinical Laboratory for Epidemiology and Applied Research in Skin (CLEARS), Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Giamarellos-Bourboulis EJ, Argyropoulou M, Kanni T, Spyridopoulos T, Otto I, Zenker O, Guo R, Riedemann NC. Clinical efficacy of complement C5a inhibition by IFX-1 in hidradenitis suppurativa: an open-label single-arm trial in patients not eligible for adalimumab. Br J Dermatol 2020; 183:176-178. [PMID: 31954061 DOI: 10.1111/bjd.18877] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- E J Giamarellos-Bourboulis
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Greece
| | - M Argyropoulou
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Greece
| | - T Kanni
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Greece
| | - T Spyridopoulos
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Greece
| | - I Otto
- InflaRx GmbH, a member of the InflaRx Group, Jena, Germany
| | - O Zenker
- InflaRx GmbH, a member of the InflaRx Group, Jena, Germany
| | - R Guo
- InflaRx GmbH, a member of the InflaRx Group, Jena, Germany
| | - N C Riedemann
- InflaRx GmbH, a member of the InflaRx Group, Jena, Germany
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61
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Seyed Jafari SM, Hunger RE, Schlapbach C. Hidradenitis Suppurativa: Current Understanding of Pathogenic Mechanisms and Suggestion for Treatment Algorithm. Front Med (Lausanne) 2020; 7:68. [PMID: 32195261 PMCID: PMC7064439 DOI: 10.3389/fmed.2020.00068] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 02/14/2020] [Indexed: 12/18/2022] Open
Abstract
Hidradenitis suppurativa is one of the most distressing dermatological conditions and has a significant negative impact on patients' quality of life. However, the exact pathogenic mechanisms remain incompletely understood and-therefore-efficient therapies are still lacking. The current manuscript focuses on new findings on its pathogenic mechanisms and aims to provide practical therapy recommendations.
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62
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Marzano AV, Chiricozzi A, Giovanardi G, Argenziano G, Bettoli V, Bianchi L, Dapavo P, Dini V, Fabbrocini G, Micali G, Offidani AM, Potenza C, Prignano F, Gualberti G, Saragaglia V, Rongioletti F. Creation of a severity index for hidradenitis suppurativa that includes a validated quality-of-life measure: the HIDRAscore. J Eur Acad Dermatol Venereol 2020; 34:1815-1821. [PMID: 32119143 PMCID: PMC7607398 DOI: 10.1111/jdv.16328] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 02/11/2020] [Indexed: 01/19/2023]
Abstract
Background Hidradenitis suppurativa (HS) is a chronic, debilitating disease with a considerable effect on patient quality of life. Its clinical severity can be measured using different scoring systems; however, few of them include patient‐centred parameters. Objective To create a new scoring system for HS that includes a quality‐of‐life instrument, the HIDRAdisk. Methods This post hoc analysis was carried out within the framework of a multicentre, longitudinal, epidemiologic study conducted over 9 months on quality‐of‐life aspects of HS. The new severity score was created using as reference a question from the Subject Satisfaction Questionnaire (SSQ) concerning the severity of HS as evaluated by the patient. Associated variables were selected using univariable and multivariable logistic regression models. The discriminant capabilities of the final model and of the final score were evaluated by the area under the receiver operating characteristic curve and the Hosmer–Lemeshow test. Results The study population included 308 patients with HS of any severity grade. According to the results of the regression models, the variables associated with the reference SSQ measure were number of inflammatory nodules, abscesses and draining fistulas; the HIDRAdisk score; and the number of subumbilical lesions. The HIDRAscore is obtained by the sum of the scores associated with the number of these parameters. Possible scores range from 0 to 10. Conclusion The HIDRAscore is a new scoring system for HS severity which, in addition to the clinical evaluation by the physician, includes a validated patient‐reported outcome measure, the HIDRAdisk.
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Affiliation(s)
- A V Marzano
- UOC Dermatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - A Chiricozzi
- Institute of Dermatology, Catholic University - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - G Giovanardi
- Institute of Dermatology, Catholic University - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - G Argenziano
- Dermatology Unit, University of Campania, Naples, Italy
| | - V Bettoli
- Dermatology Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera, University of Ferrara, Ferrara, Italy
| | - L Bianchi
- Department of Dermatology, Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - P Dapavo
- Dermatologia, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - V Dini
- U.O. Dermatologia, Università di Pisa, Pisa, Italy
| | - G Fabbrocini
- U.O.C. di Dermatologia, Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | - G Micali
- Dermatology Clinic, P.O.G. Rodolico, A.O.U. Policlinico, Vittorio Emanuele, Catania, Italy
| | - A M Offidani
- Dermatology Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - C Potenza
- Dermatology Operational Unit "Daniele Innocenzi", Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and medicine, Sapienza University of Rome - Polo Pontino- Latina, Italy
| | - F Prignano
- Clinica Dermatologica, ASF Dipartimento di Chirurgia e Medicina Translazionale, Università di Firenze, Ospedale Piero Palagi, Florence, Italy
| | | | | | - F Rongioletti
- Unit of Dermatology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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Prignano F, Pescitelli L, Giani I, Dini V, Romanelli M. Tuscan consensus on the diagnosis and treatment of hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2020; 33 Suppl 6:21-24. [PMID: 31535762 DOI: 10.1111/jdv.15825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/08/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND A rationalized model of clinical and therapeutic management of hidradenitis suppurativa (HS) should place the patients at the heart of the process, facilitating their access to diagnostic tests and treatments, providing the appropriate care for each grade of disease severity and optimizing the use of healthcare resources, both in economic and human terms. MATERIAL AND METHODS This paper reports the results of a Consensus of the Tuscany HS working group for a rationalized model of diagnosis and management of HS. RESULTS The diagnostic and therapeutic protocols, the available technological equipments and the management models, are presented in the light of today's scientific evidence. CONCLUSION The goal of the Consensus is to bring the issue of HS management to the attention of the Tuscan regional government, in order to create unanimously accepted diagnostic and therapeutic protocols.
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Affiliation(s)
- F Prignano
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - L Pescitelli
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - I Giani
- Proctologic Unit, Department of General Surgery, Santo Stefano Hospital, Prato, Italy
| | - V Dini
- Department of Dermatology, University of Pisa, Pisa, Italy
| | - M Romanelli
- Department of Dermatology, University of Pisa, Pisa, Italy
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Shavit E, Pawliwec A, Alavi A, George R. The surgeon’s perspective: a retrospective study of wide local excisions taken to healthy subcutaneous fat in the management of advanced hidradenitis suppurativa. Can J Surg 2020; 63:E94-E99. [PMID: 32109015 DOI: 10.1503/cjs.003119] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Hidradenitis suppurativa (HS) is a chronic debilitating folliculopilosebaceous disease that affects the skin most commonly in the axilla, groin, inframammary, genital and buttock areas. Surgical intervention may be an appropriate option in selected cases, but there is a risk of recurrence. The purpose of this study was to assess the results of wide local excision (WLE) to healthy subcutaneous fat with secondary intention healing in patients with HS who were under concurrent surgical and dermatologic care. Methods We conducted a retrospective review of 192 consecutive HS consultations to a general surgical service, identifying patients treated with WLE. Cases involving minor procedures (deroofing, incision and drainage) were excluded. Data on patient demographics, surgical site, method of closure, complications and recurrence were extracted from patient charts. We also conducted a literature review of surgical procedures in the management of HS. Results A total of 66 patients underwent 133 WLE to healthy subcutaneous fat. All patients were under concurrent medical care directed by a dermatologist. No medical therapies, including biological treatments, were interrupted or withheld for surgery. One hundred procedures were closed primarily with rotation or advancement flaps and 33 by secondary intention healing. Local recurrence occurred in 18% of primary closures and 18% of secondary intention closures (p = 0.98, χ2 test, no difference between groups). One patient with secondary intention healing returned to the emergency department for bleeding; 34% of patients with primary closure experienced some dehiscence (23% major, 11% minor separation). Two patients with axillary disease had restrictions in their ability to raise their arm that required physiotherapy. Median follow-up was 14.5 (range 1–55) months. Conclusion Resection to healthy subcutaneous fat during WLE provides disease control comparable to that with deeper resections, simplifying care.
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Affiliation(s)
- Eran Shavit
- From the Department of Medicine, Women’s College Hospital, and the Department of Surgery, CIBC Breast Centre, St. Michael’s Hospital, University of Toronto, Toronto, Ont
| | - Andrew Pawliwec
- From the Department of Medicine, Women’s College Hospital, and the Department of Surgery, CIBC Breast Centre, St. Michael’s Hospital, University of Toronto, Toronto, Ont
| | - Afsaneh Alavi
- From the Department of Medicine, Women’s College Hospital, and the Department of Surgery, CIBC Breast Centre, St. Michael’s Hospital, University of Toronto, Toronto, Ont
| | - Ralph George
- From the Department of Medicine, Women’s College Hospital, and the Department of Surgery, CIBC Breast Centre, St. Michael’s Hospital, University of Toronto, Toronto, Ont
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65
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Arenbergerova M, Arenberger P, Marques E, Gkalpakiotis S. Successful treatment of recalcitrant gluteal hidradenitis suppurativa with brodalumab after anti‐TNF failure. Int J Dermatol 2020; 59:733-735. [PMID: 32012238 DOI: 10.1111/ijd.14792] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 11/24/2019] [Accepted: 01/04/2020] [Indexed: 01/04/2023]
Affiliation(s)
- Monika Arenbergerova
- Department of Dermatovenereology Third Faculty of Medicine Charles University and University Hospital of Kralovske Vinohrady Prague Czech Republic
| | - Petr Arenberger
- Department of Dermatovenereology Third Faculty of Medicine Charles University and University Hospital of Kralovske Vinohrady Prague Czech Republic
| | - Emanual Marques
- Department of Dermatovenereology Third Faculty of Medicine Charles University and University Hospital of Kralovske Vinohrady Prague Czech Republic
| | - Spyridon Gkalpakiotis
- Department of Dermatovenereology Third Faculty of Medicine Charles University and University Hospital of Kralovske Vinohrady Prague Czech Republic
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66
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Gottlieb A, Natsis NE, Kerdel F, Forman S, Gonzalez E, Jimenez G, Hernandez L, Kaffenberger J, Guido G, Lucas K, Montes D, Gold M, Babcock C, Simard J. A Phase II Open-Label Study of Bermekimab in Patients with Hidradenitis Suppurativa Shows Resolution of Inflammatory Lesions and Pain. J Invest Dermatol 2020; 140:1538-1545.e2. [PMID: 32004568 DOI: 10.1016/j.jid.2019.10.024] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 10/24/2019] [Accepted: 10/31/2019] [Indexed: 01/15/2023]
Abstract
The objective of this study was to evaluate the safety and efficacy of bermekimab, an IL-1α inhibitor, in the treatment of hidradenitis suppurativa (HS). This study was a phase II, multicenter, open-label study of two dose cohorts of bermekimab in patients with moderate-to-severe HS who are naïve to or have failed prior anti-TNF therapy. Patients with HS (n = 42) were divided into groups A and B based on whether or not they had previously failed an anti-TNF therapy. In group A (n = 24), bermekimab was administered subcutaneously at a dose of 400 mg weekly (13 doses) in patients who had previously failed anti-TNF therapy; in group B (n = 18), bermekimab was administered subcutaneously at a dose of 400 mg weekly (13 doses) in patients who were anti-TNF naïve. Bermekimab, previously found to be effective in treating HS, was evaluated using a subcutaneous formulation in patients with HS naïve to or having failed anti-TNF therapy. There were no bermekimab-related adverse events with the exception of injection site reactions. Bermekimab was effective despite treatment history, with 61% and 63% of patients naïve to and having failed anti-TNF therapy, respectively, achieving HS clinical response after 12 weeks of treatment. A significant reduction in abscesses and inflammatory nodules of 60% (P < 0.004) and 46% (P < 0.001) was seen in anti-TNF naïve and anti-TNF failure groups, respectively. Clinically and statistically significant reduction was seen in patients experiencing pain, with the Visual Analogue Scale pain score reducing by 64% (P < 0.001) and 54% (P < 0.001) in the anti-TNF naïve and anti-TNF failure groups, respectively. IL-1α is emerging as an important clinical target for skin disease, and bermekimab may represent a new therapeutic option for treating moderate-to-severe HS.
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Affiliation(s)
- Alice Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Nicola E Natsis
- University of California San Diego School of Medicine, San Diego, California, USA; Rady Children's Hospital, San Diego, California, USA
| | - Francisco Kerdel
- Florida Academic Centers Research and Education, Coral Gables, Florida, USA
| | - Seth Forman
- Forward Clinical Trials Inc., Tampa, Florida, USA
| | - Edgar Gonzalez
- Oceane7 Medical & Research Center, Inc., Miami, Florida, USA
| | | | | | - Jessica Kaffenberger
- Wexner Medical Center Clinical Trials Management Organization, The Ohio State University, Columbus, Ohio, USA
| | | | - Kathryn Lucas
- Diabetes & Endocrinology Consultants, PC, Morehead City, North Carolina, USA
| | - Diego Montes
- Intervent Clinical Research Center, Pembroke Pines, Florida, USA
| | - Michael Gold
- Tennessee Clinical Research Center, Nashville, Tennessee, USA
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Constantinou CA, Fragoulis GE, Nikiphorou E. Hidradenitis suppurativa: infection, autoimmunity, or both? Ther Adv Musculoskelet Dis 2019; 11:1759720X19895488. [PMID: 31908656 PMCID: PMC6937531 DOI: 10.1177/1759720x19895488] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 11/26/2019] [Indexed: 12/13/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease mainly affecting areas rich in apocrine glands. Clinically, is characterized by painful subcutaneous nodules and if left untreated to pus secretion, abscess and fistula formation. Its frequency is estimated to be 0.5-4% of the general population, affecting women more often. Pathogenesis of HS is still not clearly defined. It seems to be a combination of genetic factors with alterations in the skin microbiome. Furthermore, at tissue (i.e. skin) as well as at serum level, several inflammatory cytokines are upregulated. The most important of the latter are tumor necrosis factor (TNF), interleukin (IL)-1, IL-17, and IL-23. Adding another level of complexity, it has been suggested that keratinocytes might be intrinsically activated, contributing also to the observed inflammation. Interestingly, it has been noted that frequency of HS is increased in some autoimmune rheumatic diseases, such as spondyloarthropathies (SpA). Of note, both HS and SpA have relatively strong association with metabolic diseases and obesity implying that there are indeed some common underlying pathophysiological pathways. Although no specific microbe has been identified, alterations in the microbiome of the skin of these patients have been reported. Of note, microbes with a capability for biofilm formation are abundant. Treatment of HS among others, include antibiotics as well as biologic drugs targeting TNF and other cytokines and used for autoimmune rheumatic diseases. Herein, we review the current evidence on links between HS and autoimmune diseases and infectious diseases with a focus on epidemiology and pathophysiology.
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Affiliation(s)
- Costas A Constantinou
- Internal Medicine Department and Tuberculosis Unit, Kyperounta Rural Hospital, Kyperounta, Cyprus
- Communicable Diseases Surveillance and Control Unit, Medical and Public Health Services, Cyprus Ministry of Heath, Nicosia, Cyprus
| | - George E Fragoulis
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
- First Department of Propaedeutic and Internal Medicine, “Laiko” General Hospital, Athens, Greece
| | - Elena Nikiphorou
- Academic Rheumatology Department, King’s College London, Cutcombe Road, London, SE5 9RJ, UK
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Frew JW, Jiang CS, Singh N, Grand D, Navrazhina K, Vaughan R, Krueger JG. Clinical response rates, placebo response rates, and significantly associated covariates are dependent on choice of outcome measure in hidradenitis suppurativa: A post hoc analysis of PIONEER 1 and 2 individual patient data. J Am Acad Dermatol 2019; 82:1150-1157. [PMID: 31881294 DOI: 10.1016/j.jaad.2019.12.044] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/12/2019] [Accepted: 12/17/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The hidradenitis suppurativa clinical response (HiSCR) is the gold standard primary outcome measure for hidradenitis suppurativa clinical trials; however, it does not assess the presence of draining tunnels, a common finding in advanced disease. It is unclear what the effect of the presence or absence of draining tunnels has on the efficacy of adalimumab therapy in moderate and advanced disease. OBJECTIVES We evaluated the efficacy of adalimumab versus placebo using the International Hidradenitis Suppurativa Severity Scoring System (IHS4). Additionally, we assessed the effect of draining tunnels on therapeutic response as measured by both the HiSCR and change in nodule counts. METHODS Reanalysis was conducted with the IHS4 and PIONEER 1 and 2 individual patient data. Both binary outcomes (achieving HiSCR and achieving change in IHS4 severity category) and continuous outcomes (nodule counts and IHS4 score) were calculated with R. Regression modeling was undertaken to assess the effect of draining tunnels and other variables. P < .05 was considered statistically significant. RESULTS The significance of adalimumab therapy depended on the outcome measure used. Placebo response rates were highest when binary outcome measures were used. Draining tunnels, smoking, antibiotics, and body mass index influenced HiSCR response in PIONEER 2. Significant differences in disease severity were observed between PIONEER 1 and 2 data sets. CONCLUSIONS Elevated placebo response rates in PIONEER 1 and 2 are partially attributable to the use of binary outcome measures. Draining tunnels influence clinical response as measured by HiSCR and nodule counts in PIONEER 2. Further investigation into the effect of body mass index on clinical response is required.
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Affiliation(s)
- John W Frew
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, New York.
| | - Caroline S Jiang
- Department of Biostatistics, The Rockefeller University, New York, New York
| | - Neha Singh
- Department of Biostatistics, The Rockefeller University, New York, New York
| | - David Grand
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, New York; Albert Einstein College of Medicine, Bronx, New York
| | - Kristina Navrazhina
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, New York; Weill Cornell/Rockefeller/Sloan Kettering Tri-Institutional MD-PhD Program, Weill Cornell University, New York, New York
| | - Roger Vaughan
- Department of Biostatistics, The Rockefeller University, New York, New York
| | - James G Krueger
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, New York
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Hayran Y, Allı N, Yücel Ç, Akdoğan N, Turhan T. Serum IL-36α, IL-36β, and IL-36γ levels in patients with hidradenitis suppurativa: association with disease characteristics, smoking, obesity, and metabolic syndrome. Arch Dermatol Res 2019; 312:187-196. [DOI: 10.1007/s00403-019-02012-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 10/21/2019] [Accepted: 11/05/2019] [Indexed: 12/14/2022]
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Abstract
Patients with hidradenitis suppurativa (HS) are often undertreated and there are limited efficacious therapies available for treating this population. Biologics are an emerging therapeutic modality used in the management of many inflammatory conditions including HS. Implementation of biologics is typically reserved for moderate-to-severe cases or in those cases that are refractory to treatment. Though many biologics have been trialed for use in HS, only one biologic, adalimumab, is currently US FDA (Food and Drug Administration) approved for the treatment of moderate-to-severe HS. Limitations in the use of biologics for HS include the many scoring systems utilized in research studies and the relatively few well-designed, adequately powered clinical trials.
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Goldfarb N, Ingram JR, Jemec GBE, Naik HB, Piguet V, Hyde MJ, Freese R, Lowes MA, Alavi A. Hidradenitis Suppurativa Area and Severity Index (HASI): a pilot study to develop a novel instrument to measure the physical signs of hidradenitis suppurativa. Br J Dermatol 2019; 182:240-242. [PMID: 31286486 DOI: 10.1111/bjd.18335] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- N Goldfarb
- Departments of Medicine and Dermatology, University of Minnesota, Minneapolis, MN, U.S.A.,Departments of Medicine and Dermatology, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, U.S.A
| | - J R Ingram
- Welsh Institute of Dermatology, University Hospital of Wales, Cardiff, U.K
| | - G B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Department of Dermatology, University of Copenhagen, Copenhagen, Denmark
| | - H B Naik
- Department of Dermatology, University of California San Francisco, San Francisco, CA, U.S.A
| | - V Piguet
- Department of Medicine, Division of Dermatology, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - M J Hyde
- The Rockefeller University, New York, NY, U.S.A
| | - R Freese
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, U.S.A
| | - M A Lowes
- The Rockefeller University, New York, NY, U.S.A
| | - A Alavi
- Department of Medicine, Division of Dermatology, Women's College Hospital, University of Toronto, Toronto, ON, Canada
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Kirby JS, Butt M, King T. Severity and Area Score for Hidradenitis (SASH): a novel outcome measurement for hidradenitis suppurativa. Br J Dermatol 2019; 182:940-948. [PMID: 31233623 DOI: 10.1111/bjd.18244] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease with a large impact on patients' health-related quality of life. However, reliable and consistent outcome measures to assess body surface area (BSA) of HS have not been established. OBJECTIVES To develop and assess the reliability and validity of a novel outcome instrument for assessment of HS BSA in a clinical trial setting. METHODS Qualitative interviews and focus groups were conducted from July to August 2015 and October 2017 to January 2018. Evaluation of the measurement was assessed during a single-day grading session with patients in April 2018. Participants, who included clinicians or patients, were recruited from academic medical centres in the U.S. mid-Atlantic region. RESULTS Concept elicitation included input from 10 providers, of which 60% (n = 6) were female, 80% (n = 8) dermatology specialists and 20% (n = 2) gynaecology specialists. Cognitive debriefing was conducted with 11 providers, of which 82% (n = 9) were dermatologists and 18% (n = 2) gynaecologists. The evaluation stage included 10 clinicians and 23 patients. The intraclass correlation coefficient (ICC) for inter-rater reliability was 0·60 [95% confidence interval (CI) 0·44-0·74]. The ICC for intrarater reliability was 0·98 (95% CI 0·94-1·00). Transformation of the BSA score resulted in an increase in inter-rater reliability to 0·75 (95% CI 0·62-0·85) or 0·76 (95% CI 0·62-0·85). Scores all demonstrated concurrent validity, with statistically significant correlations with extant scoring methods. CONCLUSIONS This novel scale is a reliable and valid HS outcome instrument and may capture a wide range of patients by assessing BSA. Future research is necessary to demonstrate its responsiveness. What's already known about this topic? The major HS disease activity scales rely on lesions counts and have moderate-to-good reliability. Body surface area (BSA) is one of the physical signs included in the Core Outcome Set for HS, but is not a part of existing HS disease activity scales. What does this study add? A novel disease severity scale, the Severity and Area Score for Hidradenitis (SASH), was developed and the psychometric properties assessed. There was high inter-rater reliability of 0·75 and 0·76 when BSA was scored on an ordinal scale, and an excellent intrarater reliability of 0·98. The SASH score also demonstrated convergent validity with extant instruments. What are the clinical implications of this work? The ability of clinicians to accurately assess disease status will be improved. Implementation of the SASH score will help guide and assess the effectiveness of appropriate treatment choice.
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Affiliation(s)
- J S Kirby
- Department of Dermatology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, U.S.A
| | - M Butt
- Department of Dermatology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, U.S.A
| | - T King
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, U.S.A
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Jemec GBE, Okun MM, Forman SB, Gulliver WPF, Prens EP, Mrowietz U, Armstrong AW, Geng Z, Gu Y, Williams DA, Teixeira HD, Kimball AB. Adalimumab medium-term dosing strategy in moderate-to-severe hidradenitis suppurativa: integrated results from the phase III randomized placebo-controlled PIONEER trials. Br J Dermatol 2019; 181:967-975. [PMID: 30916379 PMCID: PMC6899827 DOI: 10.1111/bjd.17919] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2019] [Indexed: 12/29/2022]
Abstract
Background Weekly adalimumab (Humira®) is approved for the treatment of hidradenitis suppurativa (HS) based on the 12‐week placebo‐controlled periods of the two phase III PIONEER trials. Objectives Using PIONEER integrated trial results, we aimed to evaluate the optimal medium‐term adalimumab maintenance dosing strategy for moderate‐to‐severe HS. Methods Each trial had two double‐blind periods; 12‐week Period A and 24‐week Period B. Patients randomized to adalimumab 40 mg every week (ADAew) (Period A), were rerandomized in Period B to ADAew (ADAew/ew), ADA every other week (ADAew/eow), or placebo (ADAew/pbo). Placebo‐randomized patients were reassigned in Period B to ADAew (PIONEER I) or placebo (PIONEER II). The primary outcome was HS Clinical Response (HiSCR). Patients who lost response during Period B were discontinued from the study and offered an option to enter the open‐label extension (OLE) to receive ADAew. Results are reported across the two study periods, and data were combined from the two study periods and the OLE. Results For week‐12 HiSCR achievers, the HiSCR week‐36 rate was 48·1% (ADAew/ew) vs. 46·2% (ADAew/eow) and 32·1% (ADAew/pbo). Combining (post hoc) these patients with week‐12 partial responders further differentiated outcomes in Period B (ADAew/ew 55·7% vs. ADAew/eow 40·0% and ADAew/pbo 30·1%). Period‐B adverse‐event rates were ADAew/ew 59·6% vs. ADAew/eow 57·4% and ADAew/pbo 65·0%. One patient (ADAew/ew) reported a serious infection. Conclusions Weekly adalimumab treatment, effective throughout 36 weeks, was the optimal maintenance medium‐term dosing regimen for this population. At least partial response after 12 weeks with continued weekly dosing had better outcomes than dose reduction or interruption. Patients who do not show at least a partial response to weekly adalimumab by week 12 are unlikely to benefit from continued therapy. No new safety risks were identified. What's already known about this topic? Hidradenitis suppurativa (HS) is a chronic inflammatory disease, commonly misinterpreted as an infection and treated with long‐term antibiotic regimens or surgical incisions. Based on the chronicity of HS and the lack of evidence for efficacious and safe long‐term HS treatments, it is important to evaluate medium‐ to long‐term therapies for HS. Weekly adalimumab (Humira®) is approved for the treatment of moderate‐to‐severe HS based on the two phase III PIONEER trials.
What does this study add? This study pooled data from the two PIONEER trials, providing a more robust assessment of outcomes. After at least partial treatment success with weekly adalimumab short‐term therapy (12 weeks), continuing weekly dosing during the subsequent 24 weeks had better outcomes than dose reduction or treatment interruption. Patients who do not show at least a partial response to weekly adalimumab by week 12 are unlikely to benefit from continued therapy.
Linked Comment: https://doi.org/10.1111/bjd.18437. https://www.bjdonline.com/article/adalimumab-medium-term-dosing-strategy-in-moderate-to-severe-hidradenitis-suppurativa-integrated-results-from-the-phase-iii-randomized-placebo-controlled-pioneer-t/
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Affiliation(s)
- G B E Jemec
- Department of Dermatology Zealand University Hospital, Health Sciences Faculty University of Copenhagen, Roskilde, Denmark
| | - M M Okun
- Fort HealthCare, Fort Atkinson, WI, U.S.A
| | - S B Forman
- Forward Clinical Trials, Tampa, FL, U.S.A
| | - W P F Gulliver
- Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - E P Prens
- Erasmus University Medical Center, Rotterdam, the Netherlands.,CHU de Reims, Hôpital Robert Debré, Service de Dermatologie, Reims Cedex, France
| | - U Mrowietz
- Department of Dermatology, Venereology, and Allergology, University Medical Center Schleswig-Holstein, Campus Kiel, Germany
| | - A W Armstrong
- Keck School of Medicine, University of Southern California, Los Angeles, CA, U.S.A
| | - Z Geng
- AbbVie Inc., North Chicago, IL, U.S.A
| | - Y Gu
- AbbVie Inc., North Chicago, IL, U.S.A
| | | | | | - A B Kimball
- Harvard Medical School and Beth Israel Deaconess Hospital, Boston, MA, U.S.A
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Thorlacius L, Garg A, Riis P, Nielsen S, Bettoli V, Ingram J, Marmol V, Matusiak L, Pascual J, Revuz J, Sartorius K, Tzellos T, Zee H, Zouboulis C, Saunte D, Gottlieb A, Christensen R, Jemec G. Inter‐rater agreement and reliability of outcome measurement instruments and staging systems used in hidradenitis suppurativa. Br J Dermatol 2019; 181:483-491. [DOI: 10.1111/bjd.17716] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2019] [Indexed: 12/30/2022]
Affiliation(s)
- L. Thorlacius
- Department of Dermatology Zealand University Hospital Roskilde/Health Sciences Faculty, University of Copenhagen Copenhagen Denmark
- Musculoskeletal Statistics Unit The Parker Institute, Bispebjerg and Frederiksberg Hospital The Capital Region of Denmark Copenhagen Denmark
| | - A. Garg
- Department of Dermatology Zucker School of Medicine at Hofstra/Northwell Hempstead NY U.S.A
| | - P.T. Riis
- Department of Dermatology Zealand University Hospital Roskilde/Health Sciences Faculty, University of Copenhagen Copenhagen Denmark
| | - S.M. Nielsen
- Musculoskeletal Statistics Unit The Parker Institute, Bispebjerg and Frederiksberg Hospital The Capital Region of Denmark Copenhagen Denmark
| | - V. Bettoli
- Dermatology and Venereology University of Ferrara Ferrara Italy
| | - J.R. Ingram
- Department of Dermatology & Academic Wound Healing Cardiff University Cardiff U.K
| | - V. Marmol
- Department of Dermatology Hopital Erasme, Brussels, Université Libre de Bruxelles Brussels Belgium
| | - L. Matusiak
- Department of Dermatology, Venereology and Allergology Medical University Wrocław Poland
| | - J.C. Pascual
- Department of Dermatology Hospital General Universitario de Alicante Alicante Spain
| | - J. Revuz
- 11 chaussée de la muette 75016 Paris France
| | - K. Sartorius
- Department of Dermatology Stockholm South General Hospital (Södersjukhuset) Stockholm Sweden
- Department of Clinical Science and Education Karolinska Institutet Stockholm Sweden
| | - T. Tzellos
- Department of Dermatology Faculty of Health Sciences University Hospital of North Norway Tromso Norway
| | - H.H. Zee
- Department of Dermatology Erasmus University Medical Center Rotterdam the Netherlands
| | - C.C. Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology Dessau Medical Center Brandenburg Medical School Theodor Fontane Dessau Germany
| | - D.M. Saunte
- Department of Dermatology Zealand University Hospital Roskilde/Health Sciences Faculty, University of Copenhagen Copenhagen Denmark
| | - A.B. Gottlieb
- Department of Dermatology ICahn School of Medicine at Mount Sinai New York NY U.S.A
| | - R. Christensen
- Musculoskeletal Statistics Unit The Parker Institute, Bispebjerg and Frederiksberg Hospital The Capital Region of Denmark Copenhagen Denmark
- Department of Rheumatology Odense University Hospital Odense Denmark
| | - G.B.E. Jemec
- Department of Dermatology Zealand University Hospital Roskilde/Health Sciences Faculty, University of Copenhagen Copenhagen Denmark
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Hessam S, Scholl L, Sand M, Schmitz L, Reitenbach S, Bechara FG. A Novel Severity Assessment Scoring System for Hidradenitis Suppurativa. JAMA Dermatol 2019; 154:330-335. [PMID: 29417136 DOI: 10.1001/jamadermatol.2017.5890] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Importance The variation in both clinical appearance and responses to diverse treatment options emphasize the importance of an accurate, clinically relevant, yet easy-to-use scoring system in hidradenitis suppurativa. Objective To propose and provide validation data for the newly designed Severity Assessment of Hidradenitis Suppurativa score. Design, Setting, and Participants We prospectively assessed disease severity using Hurley staging and the modified Hidradenitis Suppurativa Score in 355 patients referred to Ruhr-University Bochum Department of Dermatology between March 2016 and June 2017. We also assessed disease severity via the Severity Assessment of Hidradenitis Suppurativa score. Main Outcomes and Measures Evaluation and assessment of convergent validity and responsiveness to treatment of the Severity Assessment of Hidradenitis Suppurativa score. Results Eighty-eight of the 355 patients (134 [37.7%] men and 221 [62.3%] women with a median [IQR] age of 40 [30-49] years) were classified as Hurley stage I, 221 were Hurley stage II, and 46 were Hurley stage III, with an overall median modified Hidradenitis Suppurativa Score of 31 (interquartile range [IQR], 19.3-53). The median total Severity Assessment of Hidradenitis Suppurativa score was 6 (IQR, 4-9), significantly different among the 3 Hurley groups. The median SAHS score for patients in Hurley stage I was 5 (IQR, 3-6), 6 (IQR, 5-9) for patients in Hurley stage II, and 9 (IQR, 7-12) for patients in Hurley stage III (P < .001, Kruskal-Wallis test). Correlation analysis showed a significant correlation between the modified Hidradenitis Suppurativa Score and the Severity Assessment of Hidradenitis Suppurativa score (r = 0.79, P < .001). Disease severity assessment before and after 3 months of conservative systemic treatment showed a significant correlation between the Severity Assessment of Hidradenitis Suppurativa score and modified Hidradenitis Suppurativa Score. Both the mHSS (P = .001) and the SAHS score (P < .001) significantly differed between the baseline visit (median mHSS, 33 [IQR, 24-52]; median SAHS score, 6 [IQR, 5-9]) and the 3-month visit (median mHSS, 28 [IQR, 15-43.5]; median SAHS score, 5 [IQR, 4-6.3]). The 2 patient-reported items demonstrated excellent test-retest reliability with intraclass correlation coefficient values greater than 0.8. Conclusions and Relevance Our validation data demonstrated that the Severity Assessment of Hidradenitis Suppurativa score is a disease severity instrument that significantly correlates with Hurley staging and the modified Hidradenitis Suppurativa Score, and is responsive enough to measure treatment outcome.
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Affiliation(s)
- Schapoor Hessam
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Lisa Scholl
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Michael Sand
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Lutz Schmitz
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Sarah Reitenbach
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Falk G Bechara
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
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Chernyshov PV, Zouboulis CC, Tomas-Aragones L, Jemec GB, Svensson A, Manolache L, Tzellos T, Sampogna F, Pustisek N, van der Zee HH, Marron SE, Spillekom-van Koulil S, Bewley A, Linder D, Abeni D, Szepietowski JC, Augustin M, Finlay AY. Quality of life measurement in hidradenitis suppurativa: position statement of the European Academy of Dermatology and Venereology task forces on Quality of Life and Patient-Oriented Outcomes and Acne, Rosacea and Hidradenitis Suppurativa. J Eur Acad Dermatol Venereol 2019; 33:1633-1643. [PMID: 31037773 DOI: 10.1111/jdv.15519] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 02/04/2019] [Indexed: 02/06/2023]
Abstract
This paper is organized jointly by the European Academy of Dermatology and Venereology (EADV) Task Force (TF) on Quality of Life (QoL) and Patient-Oriented Outcomes and the EADV TF on acne, rosacea and hidradenitis suppurativa (ARHS). The purpose of this paper was to present current knowledge about QoL assessment in HS, including data on HS-specific health-related (HR) QoL instruments and HRQoL changes in clinical trials, and to make practical recommendations concerning the assessment of QoL in people with HS. HS results in significant quimp that is higher than in most other chronic skin diseases. HS impact in published studies was assessed predominantly (84% of studies) by the Dermatology Life Quality Index (DLQI). There is a lack of high-quality clinical trials in HS patients where HRQoL instruments have been used as outcome measures. One double-blind randomized placebo-controlled trial on infliximab with low number of participants reported significantly better HRQoL improvement in the treatment group than in the placebo group. Well-designed clinical studies in HS patients to compare different treatment methods, including surgical methods and assessing long-term effects, are needed. Because of lack of sufficient validation, the Task Forces are not at present able to recommend existing HS-specific HRQoL instruments for use in clinical studies. The EADV TFs recommend the dermatology-specific DLQI questionnaire for use in HS patients. The EADV TFs encourage the further development, validation and use of other HS-specific, dermatology-specific and generic instruments but such use should be based on the principles presented in the previous publications of the EADV TF on QoL and Patient-Oriented Outcomes.
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Affiliation(s)
- P V Chernyshov
- Department of Dermatology and Venereology, National Medical University, Kiev, Ukraine
| | - C C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany
| | - L Tomas-Aragones
- Department of Psychology, University of Zaragoza, Zaragoza, Spain
| | - G B Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - A Svensson
- Department of Dermatology and Venereology, Skane University Hospital, Malmö, Sweden
| | - L Manolache
- Dermatology, Dali Medical, Bucharest, Romania
| | - T Tzellos
- Department of Dermatology, Faculty of Health Sciences, University Hospital of North Norway, Troms, Norway.,Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - F Sampogna
- Clinical Epidemiology Unit, IDI-IRCCS, Rome, Italy
| | - N Pustisek
- Children's Hospital Zagreb, Medical School, University of Zagreb, Zagreb, Croatia
| | - H H van der Zee
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - S E Marron
- Department of Dermatology, Royo Villanova Hospital, Aragon Psychodermatology Research Group (GAI+PD), Zaragoza, Spain
| | - S Spillekom-van Koulil
- Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A Bewley
- Whipps Cross University Hospital, London, UK.,The Royal London Hospital, London, UK
| | - D Linder
- Unit of Dermatology, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - D Abeni
- Clinical Epidemiology Unit, IDI-IRCCS, Rome, Italy
| | - J C Szepietowski
- Department of Dermatology, Wroclaw Medical University, Wroclaw, Poland
| | - M Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Y Finlay
- Department of Dermatology and Wound Healing, Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
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Kirby JS, Moore B, Leiphart P, Shumaker K, Mammis-Gierbolini A, Benhadou F, Del Marmol V. A narrative review of the definition of 'flare' in hidradenitis suppurativa. Br J Dermatol 2019; 182:24-28. [PMID: 31025310 DOI: 10.1111/bjd.18035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic, inflammatory condition that can have periodic worsening or flares. Measurement of flare is important because it can inform treatment efficacy; however, it is unclear how HS flare should be defined. OBJECTIVES This study reviewed the literature for definitions of HS flare. METHODS The PubMed MEDLINE online database was searched on 10 January 2018 and the search was repeated on 8 December 2018 for new publications. Titles and abstracts were screened for inclusion. Subsequently, full articles were screened for inclusion. Papers were included if the publication was a systematic review, clinical trial, cohort study, case report or series, or cross-sectional study. Studies were excluded if they were journalistic reviews, did not discuss clinical findings of HS or did not use the words 'flare', 'exacerbation', 'relapse' or 'recurrence'. RESULTS Two hundred and seventy-four papers were identified and 154 fulfilled the study criteria. Of these, 27 (17.5%) included the term 'flare' and 16 (10.4%) included the term 'exacerbation'. Two of the 27 papers (7%) defined the term flare and both included patient report of changes in symptoms or signs. One of 16 papers (6%) defined exacerbation, which was taken as one new HS lesion. The terms 'recurrence' and 'relapse' were more apt to be defined: 13% (13 of 100) and 14% (six of 44), respectively. CONCLUSIONS The lack of a specific and measurable definition of HS flare is a barrier to assessment of this important outcome. Once a specific and measurable definition is established, validated and reliable measures of HS flare can be incorporated into future studies. What's already known about this topic? Hidradenitis suppurativa (HS) is a chronic, relapsing inflammatory skin condition. The ability to assess flares is important to people who have HS; however, it is unclear how this is defined. HS flare is one of the core outcomes in the core outcome set for HS clinical trials; however, it is unclear how this should be assessed. What does this study add? This literature review reveals the paucity of measurable definitions associated with the use of the term 'flare' in the HS literature. It also highlights the variation and lack of a validated and reliable measure of HS flare.
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Affiliation(s)
- J S Kirby
- Department of Dermatology, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, U.S.A
| | - B Moore
- Penn State College of Medicine, Hershey, PA, U.S.A
| | - P Leiphart
- Penn State College of Medicine, Hershey, PA, U.S.A
| | - K Shumaker
- Department of Dermatology, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, U.S.A
| | | | - F Benhadou
- Department of Dermatology, Hôpital Erasme - Universite Libre de Bruxelles, Bruxelles, Belgium
| | - V Del Marmol
- Department of Dermatology, Hôpital Erasme - Universite Libre de Bruxelles, Bruxelles, Belgium
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78
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Salomon J, Piotrowska A, Matusiak Ł, Dzięgiel P, Szepietowski JC. Chitinase-3-like Protein 1 (YKL-40) Is Expressed in Lesional Skin in Hidradenitis Suppurativa. In Vivo 2019; 33:141-143. [PMID: 30587614 DOI: 10.21873/invivo.11450] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 10/12/2018] [Accepted: 10/15/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Hidradenitis suppurativa (HS) is a chronic disease. Recently, we suggested, chitinase-3-like protein 1 (YKL-40) as a new biomarker for HS since its serum levels were found to be elevated in patients. The objective of this study was to examine YKL-40 tissue expression in HS. MATERIALS AND METHODS The study was conducted on 7 patients with HS. The biopsies were obtained from lesional and non-lesional skin. The tissue expression of YKL-40 was assessed using an immunohistochemical method. RESULTS Inflammatory infiltrates of various grades were visible in all samples of lesional skin. The inflammatory cells within those infiltrates showed a strong cytoplasmic expression of YKL-40. In non-lesional HS skin the pattern of YKL-40 expression was similar to that observed in healthy skin. CONCLUSION Inflammatory infiltrates in HS skin lesions may be responsible for the elevated YKL-40 serum level. YKL-40 can be considered one of the most valuable biomarkers of HS.
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Affiliation(s)
- Joanna Salomon
- Department of Dermatology, Venereology and Allergology, Wrocław Medical University, Wrocław, Poland
| | - Aleksandra Piotrowska
- Department of Human Morphology and Embryology, Wrocław Medical University, Wrocław, Poland
| | - Łukasz Matusiak
- Department of Dermatology, Venereology and Allergology, Wrocław Medical University, Wrocław, Poland
| | - Piotr Dzięgiel
- Department of Human Morphology and Embryology, Wrocław Medical University, Wrocław, Poland
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wrocław Medical University, Wrocław, Poland
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79
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Magalhães RF, Rivitti-Machado MC, Duarte GV, Souto R, Nunes DH, Chaves M, Hirata SH, Ramos AMC. Consensus on the treatment of hidradenitis suppurativa - Brazilian Society of Dermatology. An Bras Dermatol 2019; 94:7-19. [PMID: 31166401 PMCID: PMC6544037 DOI: 10.1590/abd1806-4841.20198607] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 09/13/2018] [Indexed: 12/27/2022] Open
Abstract
Hidradenitis suppurativa is a chronic immune mediated disease of universal distribution that causes great damage to the quality of life of the affected individual, whose prevalence is estimated at 0.41% in the Brazilian population. The objective of this work was update on physiopathogenesis, diagnosis and classification of hidradenitis suppurativa and to establish therapeutic recommendations in the Brazilian reality. It was organized as a work group composed of eight dermatologists from several institutions of the country with experience in the treatment of hidradenitis suppurativa and carried out review on the topic. Recommendations were elaborated and voted by modified Delphi system and statistical analysis of the results was performed. The Brazilian consensus on the clinical approach of hidradenitis suppurativa had the support of the Brazilian Society of Dermatology.
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Affiliation(s)
- Renata Ferreira Magalhães
- Discipline of Dermatology, Department of Internal Medicine,
Universidade Estadual de Campinas, Campinas (SP), Brazil
| | | | | | - Roberto Souto
- Dermatology Service, Hospital Universitário Pedro Ernesto,
Universidade do Estado do Rio de Janeiro, Rio de Janeiro (RJ), Brazil
| | - Daniel Holthausen Nunes
- Dermatology Service, Hospital Universitário, Universidade
Federal de Santa Catarina, Florianópolis (SC), Brazil
| | - Mario Chaves
- Dermatology Service, Hospital Universitário Pedro Ernesto,
Universidade do Estado do Rio de Janeiro, Rio de Janeiro (RJ), Brazil
| | | | - Andrea Machado Coelho Ramos
- Dermatology Service, Hospital de Clínicas, Universidade
Federal de Minas Gerais, Belo Horizonte (MG), Brazil
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80
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Ingram JR, Collier F, Brown D, Burton T, Burton J, Chin MF, Desai N, Goodacre TEE, Piguet V, Pink AE, Exton LS, Mohd Mustapa MF. British Association of Dermatologists guidelines for the management of hidradenitis suppurativa (acne inversa) 2018. Br J Dermatol 2019; 180:1009-1017. [PMID: 30552762 DOI: 10.1111/bjd.17537] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2018] [Indexed: 02/06/2023]
Affiliation(s)
- J R Ingram
- Division of Infection & Immunity, Cardiff University, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, U.K
| | - F Collier
- Alva Medical Practice, West Johnstone Street, Alva, FK12 5BD, U.K.,Dermatology Department, Stirling Community Hospital, Stirling, FK8 2AU, U.K
| | - D Brown
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, SE1 7EH, U.K
| | - T Burton
- The Hidradenitis Suppurativa Trust, Rochester ME2 4DY, U.K
| | - J Burton
- The Hidradenitis Suppurativa Trust, Rochester ME2 4DY, U.K
| | - M F Chin
- Great Western Hospitals NHS Foundation Trust, Marlborough Road, Swindon, Wiltshire, SN3 6BB, U.K
| | - N Desai
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, SE1 7EH, U.K
| | - T E E Goodacre
- Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, U.K
| | - V Piguet
- Division of Infection & Immunity, Cardiff University, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, U.K.,Division of Dermatology, Women's College Hospital, Toronto, ON, Canada.,Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - A E Pink
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, SE1 7EH, U.K
| | - L S Exton
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, U.K
| | - M F Mohd Mustapa
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, U.K
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81
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Peris K, Lo Schiavo A, Fabbrocini G, Dini V, Patrizi A, Fusano M, Bianchi L, Guanziroli E, Guarneri C, Parodi A, Bertoldi A, Musumeci ML, Offidani A, Rongioletti F, Pistone G, Malara G, Potenza C, Casari A, Franchi C, Ardigò M, Cusano F, Stingeni L, Amerio P, Mancini LL, Prignano F, Deboli T, Gualberti G, Saragaglia V, Bettoli V. HIDRAdisk: validation of an innovative visual tool to assess the burden of hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2019; 33:766-773. [PMID: 30633405 PMCID: PMC6593467 DOI: 10.1111/jdv.15425] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 12/03/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic, relapsing, inflammatory skin disease characterized by painful inflamed nodules, recurrent abscesses and fistulas located in apocrine gland-bearing body sites. The negative impact of HS on patient's quality of life (QoL) has been reported to be greater than other dermatologic conditions as psoriasis and atopic eczema, and its improvement is an important goal in disease management. Nowadays, there are no specific validated QoL instruments available for HS and generic dermatologic questionnaires are used. OBJECTIVE The objective of this study was to demonstrate the validity, reliability and responsiveness of HIDRAdisk, a new innovative tool designed for rapid assessment of HS burden and, at the same time, an intuitive graphic visualization of the measurement outcome. METHODS A multicentre, longitudinal, observational study was conducted to validate the HIDRAdisk compared with other validated questionnaires [Skindex-16, Dermatology Life Quality Index (DLQI), Work Productivity and Activity Impairment-General Health (WPAI:GH)] and to evaluate its correlation with disease severity in Italian patients with any degree of HS severity, as measured by Hurley stage and HS Physician Global Assessment (HS-PGA). RESULTS A total of 140 patients (59% women; mean age 34.9 ± 11.0 years) were enrolled in 27 dermatologic centres. HIDRAdisk showed a strong correlation with Skindex-16 and DLQI, and a good one with WPAI:GH (correlation coefficient: 0.7568, 0.6651 and 0.5947, respectively) and a statistically significant correlation with both Hurley stage and HS-PGA. Very good internal consistency (Cronbach coefficient >0.80; intraclass correlation coefficient >0.6), with correlation between the 10 items, good test-retest reliability (Spearman correlation coefficient, 0.8331; P < 0.0001) and responsiveness to changes were demonstrated. CONCLUSION Our study shows that HIDRAdisk, a short and innovative visual HS QoL instrument, has been psychometrically validated in Italian language and it may help improve the management of HS once implemented in routine clinical practice.
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Affiliation(s)
- K Peris
- Istituto di Dermatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Lo Schiavo
- Unità di Dermatologia, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - G Fabbrocini
- U.O.C. di Dermatologia- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli "Federico II", Naples, Italy
| | - V Dini
- U.O. Dermatologia, Università di Pisa, Pisa, Italy
| | - A Patrizi
- Dermatologia, DIMES (Dipartimento di Medicina clinica Specialistica e Sperimentale), Università di Bologna, Bologna, Italy
| | - M Fusano
- ASST Spedali Civili of Brescia, U.O. Dermatologia e Venereologia, Università di Brescia, Brescia, Italy
| | - L Bianchi
- Unità Operativa di Dermatologia, Policlinico Tor Vergata, Università degli studi di Roma Tor Vergata, Rome, Italy
| | - E Guanziroli
- Dipartimento di Fisiopatologia, IRCCS Fondazione Ca' Granda - Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - C Guarneri
- Dipartimento di Scienze Biomediche e Dentali e Imaging Morfofunzionale, Unità di Dermatologia, Università di Messina, Messina, Italy
| | - A Parodi
- DiSSal Sezione di Dermatologia, Università di Genova, Ospedale-Policlinico San Martino, Genoa, Italy
| | - A Bertoldi
- Dipartimento di Dermatologia, Ospedale "Santi Giovanni e Paolo", Venice, Italy
| | - M L Musumeci
- Dermatology Clinic, P.O. G. Rodolico, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy
| | - A Offidani
- SOD Clinica di Dermatologia, Università Politecnica delle Marche, Azienda Ospedaliera Universitaria, Ancona, Italy
| | - F Rongioletti
- Clinica Dermatologica, Dipartimento di scienze Mediche e Salute Pubblica, Università di Cagliari, Cagliari, Italy
| | - G Pistone
- Dipartimento Di.Bi. MIS, U.O.C. di Dermatologia e MTS, A.O.U.P "Paolo Giaccone", Palermo, Italy
| | - G Malara
- Struttura Complessa presso la UOC di Dermatologia GOM "Bianchi Melacrino Morelli", Reggio Calabria, Italy
| | - C Potenza
- Facoltà di Farmacia e Medicina, U.O.C. di Dermatologia "Daniele Innocenzi", Università degli Studi di Roma "Sapienza", Polo Pontino, Italy
| | - A Casari
- Clinica Dermatologica, Policlinico di Modena, Modena, Italy
| | - C Franchi
- UO dermatologia, IRCCS Galeazzi, Milan, Italy
| | - M Ardigò
- U.O.C. di Dermatologia Clinica, IFO-San Gallicano, IRCCS, Rome, Italy
| | - F Cusano
- U.O.C. di Dermatologia, A.O. Gaetano Rummo, Benevento, Italy
| | - L Stingeni
- Sezione di Dermatologia Clinica, Allergologica e Venereologica, Dipartimento di Medicina, Università di Perugia, Perugia, Italy
| | - P Amerio
- Dipartimento di Medicina e Scienze dell'Invecchiamento, Università G. d'Annunzio, Chieti, Italy
| | - L L Mancini
- Unità di Dermatologia, IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy
| | - F Prignano
- Clinica Dermatologica - ASF Dipartimento di Chirurgia e Medicina Translazionale, Ospedale Piero Palagi, Università di Firenze, Florence, Italy
| | - T Deboli
- Dermatologia, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | | | | | - V Bettoli
- Dipartimento di Medicina Clinica e Specialistica, U.O. di Dermatologia, A.O.U. di Ferrara, Ferrara, Italy
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82
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Argyropoulou M, Kanni T, Kyprianou M, Melachroinopoulos N, Giamarellos‐Bourboulis E. Cost‐savings of adalimumab in hidradenitis suppurativa: a retrospective analysis of a real‐world cohort. Br J Dermatol 2018; 180:1161-1168. [DOI: 10.1111/bjd.17151] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2018] [Indexed: 12/17/2022]
Affiliation(s)
- M. Argyropoulou
- 4th Department of Internal Medicine National and Kapodistrian University of Athens Athens Greece
| | - T. Kanni
- 4th Department of Internal Medicine National and Kapodistrian University of Athens Athens Greece
| | - M. Kyprianou
- 4th Department of Internal Medicine National and Kapodistrian University of Athens Athens Greece
| | - N. Melachroinopoulos
- 4th Department of Internal Medicine National and Kapodistrian University of Athens Athens Greece
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83
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Ahn C, Fang X, Silverman P, Zhang Z. A quantitative method for measuring the relationship between an objective endpoint and patient reported outcome measures. PLoS One 2018; 13:e0205845. [PMID: 30359417 PMCID: PMC6201893 DOI: 10.1371/journal.pone.0205845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 10/02/2018] [Indexed: 12/02/2022] Open
Abstract
Patient reported outcome measures (PROMs) become increasingly important for assessing the effectiveness of a drug or medical device. In order for a PROM to be claimed in labeling, the PROM has to be valid, reliable and able to detect a change if the targeted disease status changes. One approach to assess the quality of a patient reported outcome measure (PROM) is to investigate the association between the PROM and an objective clinical endpoint measuring the status of a disease/condition. However, methods assessing the association between continuous and discrete variables are limited, especially for correlated measurements. In this paper, we propose a method to assess such association with any type of samples with or without correlation. The method involves estimating the probability revealing the status of a subject’s disease/condition (called truth thereafter) through the subject’s reported outcomes. The probability is a conditional probability revealing truth given the relative location of the subject’s objective outcome compared to the subject-specific latent threshold in the objective endpoint. A consistent estimator for the probability is derived. The operating characteristics of the consistent estimator are illustrated using simulation. Our method is applied to hypothetical clinical trial data generated for an ophthalmic device as an illustration.
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Affiliation(s)
- Chul Ahn
- Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Xin Fang
- Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland, United States of America
- * E-mail:
| | - Phyllis Silverman
- Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Zhiwei Zhang
- Department of Statistics, University of California, Riverside, CA, United States of America
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84
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Zouboulis CC, Bechara FG, Dickinson-Blok JL, Gulliver W, Horváth B, Hughes R, Kimball AB, Kirby B, Martorell A, Podda M, Prens EP, Ring HC, Tzellos T, van der Zee HH, van Straalen KR, Vossen ARJV, Jemec GBE. Hidradenitis suppurativa/acne inversa: a practical framework for treatment optimization - systematic review and recommendations from the HS ALLIANCE working group. J Eur Acad Dermatol Venereol 2018; 33:19-31. [PMID: 30176066 PMCID: PMC6587546 DOI: 10.1111/jdv.15233] [Citation(s) in RCA: 141] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/06/2018] [Indexed: 12/17/2022]
Abstract
Hidradenitis suppurativa (HS)/acne inversa is a debilitating chronic disease that remains poorly understood and difficult to manage. Clinical practice is variable, and there is a need for international, evidence‐based and easily applicable consensus on HS management. We report here the findings of a systematic literature review, which were subsequently used as a basis for the development of international consensus recommendations for the management of patients with HS. A systematic literature review was performed for each of nine clinical questions in HS (defined by an expert steering committee), covering comorbidity assessment, therapy (medical, surgical and combinations) and response to treatment. Included articles underwent data extraction and were graded according to the Oxford Centre for Evidence‐based Medicine criteria. Evidence‐based recommendations were then drafted, refined and voted upon, using a modified Delphi process. Overall, 5310 articles were screened, 171 articles were analysed, and 65 were used to derive recommendations. These articles included six randomized controlled trials plus cohort studies and case series. The highest level of evidence concerned dosing recommendations for topical clindamycin in mild disease (with systemic tetracyclines for more frequent/widespread lesions) and biologic therapy (especially adalimumab) as second‐line agents (following conventional therapy failure). Good‐quality evidence was available for the hidradenitis suppurativa clinical response (HiSCR) as a dichotomous outcome measure in inflammatory areas under treatment. Lower‐level evidence supported recommendations for topical triclosan and oral zinc in mild‐to‐moderate HS, systemic clindamycin and rifampicin in moderate HS and intravenous ertapenem in selected patients with more severe disease. Intralesional or systemic steroids may also be considered. Local surgical excision is suggested for mild‐to‐moderate HS, with wide excision for more extensive disease. Despite a paucity of good‐quality data on management decisions in HS, this systematic review has enabled the development of robust and easily applicable clinical recommendations for international physicians based on graded evidence.
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Affiliation(s)
- C C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany
| | - F G Bechara
- Dermatologic Surgery Unit, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - J L Dickinson-Blok
- Department of Dermatology, Hospital Nij Smellinghe, Drachten, The Netherlands
| | - W Gulliver
- Division of Dermatology, Memorial University of Newfoundland, St. John's, NL, Canada
| | - B Horváth
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - R Hughes
- Department of Dermatology, St Vincent's University Hospital, Dublin, Ireland
| | - A B Kimball
- Department of Dermatology, Harvard Medical School, Boston, MA, USA
| | - B Kirby
- Department of Dermatology, St Vincent's University Hospital, Dublin, Ireland
| | - A Martorell
- Department of Dermatology, Hospital de Manises, Valencia, Spain
| | - M Podda
- Department of Dermatology, Medical Center Klinikum Darmstadt, Darmstadt, Germany
| | - E P Prens
- Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - H C Ring
- Department of Dermatology, Zealand University Hospital, University of Copenhagen, Roskilde, Denmark
| | - T Tzellos
- Department of Dermatology, Faculty of Health Sciences, University Hospital of North Norway, Harstad and Institute of Clinical Medicine, Arctic University, Tromsø, Norway
| | - H H van der Zee
- Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands.,DermaHaven, Rotterdam, The Netherlands
| | - K R van Straalen
- Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - A R J V Vossen
- Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - G B E Jemec
- Department of Dermatology, Zealand University Hospital, University of Copenhagen, Roskilde, Denmark
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85
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Bettoli V, Manfredini M, Calamo G, Forconi R, Bencivelli D, Mantovani L, Pellacani G, Corazza M. Long-term adalimumab treatment of hidradenitis suppurativa: Results and practical insights from a real-life experience. Dermatol Ther 2018; 31:e12737. [PMID: 30295378 DOI: 10.1111/dth.12737] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 08/23/2018] [Accepted: 08/29/2018] [Indexed: 11/30/2022]
Affiliation(s)
- V Bettoli
- Department of Medical Sciences, Section of Dermatology, University of Ferrara, Ferrara, Italy
| | - M Manfredini
- Department of Medical Sciences, Section of Dermatology, University of Ferrara, Ferrara, Italy.,Department of Surgical, Medical, Dental & Morphological Sciences with Interest Transplant, Oncological & Regenerative Medicine, Dermatology Unit, University of Modena & Reggio Emilia, Modena, Italy
| | - G Calamo
- Department of Medical Sciences, Section of Dermatology, University of Ferrara, Ferrara, Italy
| | - R Forconi
- Department of Medical Sciences, Section of Dermatology, University of Ferrara, Ferrara, Italy
| | - D Bencivelli
- Department of Medical Sciences, Section of Dermatology, University of Ferrara, Ferrara, Italy
| | - L Mantovani
- Department of Medical Sciences, Section of Dermatology, University of Ferrara, Ferrara, Italy
| | - G Pellacani
- Department of Surgical, Medical, Dental & Morphological Sciences with Interest Transplant, Oncological & Regenerative Medicine, Dermatology Unit, University of Modena & Reggio Emilia, Modena, Italy
| | - M Corazza
- Department of Medical Sciences, Section of Dermatology, University of Ferrara, Ferrara, Italy
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86
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Kyriakou A, Trigoni A, Galanis N, Sotiriadis D, Patsatsi A. Efficacy of adalimumab in moderate to severe hidradenitis suppurativa: Real life data. Dermatol Reports 2018; 10:7859. [PMID: 30370041 PMCID: PMC6187007 DOI: 10.4081/dr.2018.7859] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 09/19/2018] [Indexed: 12/17/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a relapsing, inflammatory disease characterized by painful nodules, abscesses, sinuses track formation and scarring. HS has a great impact on patients’ quality of life and its treatment may be really challenging. Adalimumab provides a new therapeutic option for HS. Our aim was to assess the therapeutic potential of adalimumab on patients with HS based on the data from the daily clinical practice of an HS Outpatient Clinic. 19 patients with clinically evident moderate to severe HS, under adalimumab treatment for at least 24 week, participated in this observational, retrospective study. The Hidradenitis Suppurativa Physician’s Global Assessment scale, Modified Santorius scale and Dermatology Life Quality Index (DLQI) at baseline, week 4, week 12 and week 24 were retrieved from the records. Both Modified Santorius score and DLQI were significantly decreased during the weeks of evaluation (Friedman’s test; P < 0.001). The proportion of patients who achieved clinical response was 10.5% (n = 2) at week 4, 42.1% (n = 8) at week 12 and 63.2% (n = 12) at week 24. Treatment with adalimumab was linked with both clinical remission of HS and improvement of patients’ quality of life.
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Affiliation(s)
- Aikaterini Kyriakou
- Second Department of Dermatology and Venereology, Aristotle University of Thessaloniki, General Hospital "Papageorgiou"
| | - Anastasia Trigoni
- Second Department of Dermatology and Venereology, Aristotle University of Thessaloniki, General Hospital "Papageorgiou"
| | - Nikiforos Galanis
- Division of Sports Medicine, Department of Orthopedics, Medical School, Aristotle University of Thessaloniki, Greece
| | - Dimitrios Sotiriadis
- Second Department of Dermatology and Venereology, Aristotle University of Thessaloniki, General Hospital "Papageorgiou"
| | - Aikaterini Patsatsi
- Second Department of Dermatology and Venereology, Aristotle University of Thessaloniki, General Hospital "Papageorgiou"
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87
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Kimball AB, Ganguli A, Fleischer A. Reliability of the hidradenitis suppurativa clinical response in the assessment of patients with hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2018; 32:2254-2256. [PMID: 29959796 DOI: 10.1111/jdv.15163] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 06/18/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hidradenitis suppurativa clinical response (HiSCR) is a validated clinical end point for measuring response to treatment in patients with hidradenitis suppurativa (HS). Previous studies have reported on the validity, responsiveness and meaningfulness of the HiSCR. OBJECTIVE To evaluate the HiSCR for inter- and intrarater reliability characteristics. METHODS A stand-alone, two-site, prospective, non-interventional observational study consisted of 22 patients, with self-reported severity between mild, moderate and severe HS. The Patient Global Impression of Change (PGI-C) scale was completed by patients at Timepoint 2. Descriptive statistics of Hurley Stage, total abscesses, total draining fistulas, total inflammatory nodules and total AN count (sum of inflammatory nodules and lesions) were reported at two timepoints. Inter-rater reliability and intrarater reliability for the HS lesion count tool were evaluated at two timepoints (baseline and Day 7) using the HS lesion count tool. Intraclass correlation (ICC) coefficients of lesion counts were calculated to evaluate inter- and intrarater reliability of lesion counts between pairs of dermatologists. RESULTS The majority of patients demonstrated either no change or minimally worse PGI-C in HS scores. Descriptive statistics were similar between rater groups and timepoints assessed. Inter-rater ICC coefficients for abscess count at Timepoints 1 and 2 were 0.38 and 0.67. The ICC coefficients for draining fistula and AN count were ≥0.61 at both timepoints. In an exploratory model, ICC coefficients were ≥0.68 for all evaluated lesion counts. The test-retest reliability using ICC coefficients was ≥0.70 for total abscess, draining fistula, inflammatory nodule and AN count. CONCLUSION The HS lesion count tool had an acceptable inter- and intrarater reliability, indicating that HiSCR has a strong degree of reproducibility and consistency in the evaluation of patients with HS.
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Affiliation(s)
- A B Kimball
- Department of Dermatology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Analysis Group Inc, Boston, MA, USA
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88
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van Straalen KR, Schneider-Burrus S, Prens EP. Current and future treatment of hidradenitis suppurativa. Br J Dermatol 2018; 183:e178-e187. [PMID: 29981245 DOI: 10.1111/bjd.16768] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2018] [Indexed: 12/13/2022]
Abstract
This scholarly review on the current and future treatment of hidradenitis suppurativa (HS) focuses on medical and surgical treatment options, while novel pipeline drugs are also discussed. Treatment goals are to limit the incidence and duration of flares, reducing inflammation and suppuration, achieving local cure after surgery and, most importantly, to improve the quality of life of patients with HS. The type of medication and/or surgery should be chosen based on the stage of the disease and the degree of inflammation. However, the lack of a simple scoring system and the lack of clear surgical outcome definitions hamper the interpretation of treatment efficacy and the comparison between different treatment strategies. The therapeutic pipeline for HS is gradually expanding, and will probably lead to a broader panel of more effective therapeutic options.
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Affiliation(s)
- K R van Straalen
- Department of Dermatology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - S Schneider-Burrus
- Department of Dermatology, University Hospital Charité, Berlin, Germany.,Centre for Dermatosurgery, Havelklinik, Berlin, Germany
| | - E P Prens
- Department of Dermatology, Erasmus University Medical Centre, Rotterdam, the Netherlands
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89
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Vossen ARJV, van Doorn MBA, van der Zee HH, Prens EP. Apremilast for moderate hidradenitis suppurativa: Results of a randomized controlled trial. J Am Acad Dermatol 2018; 80:80-88. [PMID: 30482392 DOI: 10.1016/j.jaad.2018.06.046] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 06/20/2018] [Accepted: 06/20/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Effective anti-inflammatory treatments for hidradenitis suppurativa (HS) are limited. OBJECTIVE To evaluate the efficacy and short-term safety of apremilast in patients with moderate HS. METHODS A total of 20 patients with moderate HS were randomized in a 3:1 ratio to receive blinded treatment with apremilast, 30 mg twice daily, or placebo for 16 weeks. The primary outcome was the Hidradenitis Suppurativa Clinical Response at week 16. Linear mixed effects modeling (analysis of covariance) was used to assess secondary clinical outcomes between treatment groups. RESULTS The HS clinical response was met in 8 of 15 patients in the apremilast group (53.3%) and none of 5 patients in the placebo group (0%) (P = .055) at week 16. Moreover, the apremilast-treated patients showed a significantly lower abscess and nodule count (mean difference, -2.6; 95% confidence interval, -6.0 to -0.9; P = .011), NRS for pain (mean difference, -2.7; 95% -4.5 to -0.9; P = .009), and itch (mean difference, -2.8; 95% confidence interval, -5.0 to -0.6; P = .015) over 16 weeks compared with the placebo-treated patients. There was no significant difference in the Dermatology Life Quality Index over time between the 2 treatment groups (mean difference, -3.4; 95% confidence interval, -9.0 to 2.3; P = .230). The most frequently reported adverse events in the apremilast-treated patients were mild-to-moderate headache and gastrointestinal symptoms, which did not result in dropouts. LIMITATIONS Small number of patients, relatively short study duration. CONCLUSION Apremilast, at a dose of 30 mg twice daily, demonstrated clinically meaningful efficacy and was generally well tolerated in patients with moderate HS.
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Affiliation(s)
- Allard R J V Vossen
- 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
| | - Hessel H van der Zee
- 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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90
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Mulani S, McNish S, Jones D, Shanmugam VK. Prevalence of antinuclear antibodies in hidradenitis suppurativa. Int J Rheum Dis 2018; 21:1018-1022. [PMID: 29878616 DOI: 10.1111/1756-185x.13312] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The purpose of this study was to investigate the prevalence of antinuclear antibody (ANA) positivity in a cohort of patients with hidradenitis suppurativa (HS), and to assess the frequency of seroconversion during treatment with tumor necrosis factor (TNF)-α inhibitor therapy. METHODS This prospective study was conducted through the Wound Etiology and Healing (WE-HEAL) Study. Immunofluorescence ANA testing was performed at baseline, and repeated when clinically indicated. ANA titers of ≥1 : 160 were considered positive. Data were collected on demographics and disease activity scores including the Hurley stage, the HS Sartorius score (HSS) and the active nodule (AN) count. RESULTS At the time of data lock, 73 patients with a confirmed diagnosis of HS were enrolled, and four (5.4%) had baseline positive ANA. None of the patients had clinical evidence of systemic lupus erythematosus or other autoimmune diseases. There were no significant differences in demographics, baseline HSS (43.25 ± 47.55 compared to 59.48 ± 56.67, P = 0.58) or AN count (3.25 ± 3.20 compared to 3.45 ± 2.36, P = 0.87) in the ANA positive group. Of the 69 patients who were ANA negative at enrollment, 31 (45%) received TNF-α inhibitor therapy. During follow up, one patient developed drug-induced lupus secondary to TNF-α inhibitor use. Additionally, one patient seroconverted to ANA positive without sequelae and one patient developed drug-induced hepatitis secondary to TNF-α inhibitor use. CONCLUSION The prevalence of baseline ANA positivity in this HS population was similar to that seen in the general population (5.4%). The rate of seroconversion and drug-induced complications in this population were low.
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Affiliation(s)
- Shaunak Mulani
- Division of Rheumatology, School of Medicine and Health Sciences, Ideas to Health Laboratory, The George Washington University, Washington, District of Columbia, USA
| | - Sean McNish
- Division of Rheumatology, School of Medicine and Health Sciences, Ideas to Health Laboratory, The George Washington University, Washington, District of Columbia, USA
| | - Derek Jones
- Division of Rheumatology, School of Medicine and Health Sciences, Ideas to Health Laboratory, The George Washington University, Washington, District of Columbia, USA
| | - Victoria K Shanmugam
- Division of Rheumatology, School of Medicine and Health Sciences, Ideas to Health Laboratory, The George Washington University, Washington, District of Columbia, USA
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91
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Zouboulis CC, Okun MM, Prens EP, Gniadecki R, Foley PA, Lynde C, Weisman J, Gu Y, Williams DA, Jemec GBE. Long-term adalimumab efficacy in patients with moderate-to-severe hidradenitis suppurativa/acne inversa: 3-year results of a phase 3 open-label extension study. J Am Acad Dermatol 2018; 80:60-69.e2. [PMID: 29860040 DOI: 10.1016/j.jaad.2018.05.040] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 05/01/2018] [Accepted: 05/21/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND The optimal long-term dosing strategy for adalimumab (ADA) in hidradenitis suppurativa/acne inversa (HS) was evaluated by pooling the results of the PIONEER phase 3 trials and an open-label extension (OLE) study. OBJECTIVE To assess the response to and tolerability of long-term administration of ADA in HS. METHODS The durations of the PIONEER I/II periods A, B, and OLE were 12, 24, and 52 or more weeks, respectively. Patients who entered the OLE and received ADA (40 mg every week continuously) and responders plus partial responders (PRRs) were evaluated. Primary efficacy assessments included measurement of HS clinical response (HiSCR), lesion counts, skin pain, and Dermatology Life Quality Index (DLQI). Treatment-emergent adverse events were assessed. RESULTS At week 12, 52.3% of those receiving ADA weekly and 73.0% of PRRs achieved HiSCR. Achievement of HiSCR was maintained through week 168 in 52.3% of patients who received ADA weekly and 57.1% of PRRs. Sustained improvement in lesion counts, skin pain, and DLQI score were also observed. The safety profile throughout the OLE was similar to the profiles observed in the PIONEER studies. LIMITATIONS The OLE was uncontrolled. CONCLUSION Continuous weekly dosing with ADA, 40 mg, is a reasonable treatment option for long-term control of moderate-to-severe HS.
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Affiliation(s)
- Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology, and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany.
| | | | - Errol P Prens
- Department of Dermatology, Erasmus University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Robert Gniadecki
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Peter A Foley
- Department of Medicine (Dermatology), The University of Melbourne, St Vincent's Hospital Melbourne, and Probity Medical Research, Skin & Cancer Foundation Inc, Melbourne, Australia
| | - Charles Lynde
- The Lynde Centre for Dermatology and Probity Medical Research, Markham, Ontario, Canada
| | | | - Yihua Gu
- AbbVie Inc, North Chicago, Illinois
| | | | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital, Health Sciences Faculty, University of Copenhagen, Roskilde, Denmark
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92
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Thorlacius L, Theut Riis P, Jemec G. Severe hidradenitis suppurativa responding to treatment with secukinumab: a case report. Br J Dermatol 2018; 179:182-185. [DOI: 10.1111/bjd.15769] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2017] [Indexed: 12/20/2022]
Affiliation(s)
- L. Thorlacius
- Department of Dermatology; Zealand University Hospital; Roskilde Denmark
- Health Sciences Faculty; University of Copenhagen; Copenhagen Denmark
- Musculoskeletal Statistics Unit; The Parker Institute, Bispebjerg and Frederiksberg Hospital; Copenhagen Denmark
| | - P. Theut Riis
- Department of Dermatology; Zealand University Hospital; Roskilde Denmark
- Health Sciences Faculty; University of Copenhagen; Copenhagen Denmark
| | - G.B.E. Jemec
- Department of Dermatology; Zealand University Hospital; Roskilde Denmark
- Health Sciences Faculty; University of Copenhagen; Copenhagen Denmark
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93
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Balevi A, Ustuner P, Özdemir M. The efficacy of adalimumab in the treatment of hidradenitis suppurativa. DICLE MEDICAL JOURNAL 2018. [DOI: 10.5798/dicletip.407240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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94
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Boortalary T, Misra K, McNish S, Jones D, Shanmugam VK. Prevalence of positive QuantiFERON gold in-tube testing in hidradenitis suppurativa. J DERMATOL TREAT 2018; 29:637-640. [PMID: 29325465 DOI: 10.1080/09546634.2018.1425360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIM Hidradenitis suppurativa (HS) is a chronic, recurrent, inflammatory disease of the apocrine sweat glands. Tumor necrosis factor-alpha (TNF-α) inhibitors are commonly used to treat HS. However, prior to initiating therapy patients must be screened for mycobacterium tuberculosis (mTB) exposure. Several mTB screening tests based on interferon gamma release assays are commercially available, but the performance of these assays in the HS population is unknown. The purpose of this study was to investigate the performance of the QuantiFERON gold in-tube assay (QFT-GIT) in a cohort of patients with HS. METHODS This prospective study was conducted through the Wound Etiology and Healing (WE-HEAL) study. QFTGIT testing was performed using a commercial laboratory. Patients with positive test results underwent follow-up testing to evaluate for latent tuberculosis infection (LTBI). Data were collected on demographics and disease activity scores including Hurley stage, HS Sartorius score (HSS) and active nodule (AN) count. RESULTS Of the 69 patients with a confirmed diagnosis of HS, seven (10.1%) tested QFT-GIT positive and 5.8% were diagnosed with LTBI. CONCLUSIONS QFT-GIT results did not correlate with demographic characteristics or HS disease activity.
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Affiliation(s)
- Tina Boortalary
- a Division of Rheumatology, Ideas to Health Laboratory , The George Washington University, School of Medicine and Health Sciences , Washington , DC , USA
| | - Kanchan Misra
- a Division of Rheumatology, Ideas to Health Laboratory , The George Washington University, School of Medicine and Health Sciences , Washington , DC , USA
| | - Sean McNish
- a Division of Rheumatology, Ideas to Health Laboratory , The George Washington University, School of Medicine and Health Sciences , Washington , DC , USA
| | - Derek Jones
- a Division of Rheumatology, Ideas to Health Laboratory , The George Washington University, School of Medicine and Health Sciences , Washington , DC , USA
| | - Victoria K Shanmugam
- a Division of Rheumatology, Ideas to Health Laboratory , The George Washington University, School of Medicine and Health Sciences , Washington , DC , USA
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95
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Shanmugam VK, Mulani S, McNish S, Harris S, Buescher T, Amdur R. Longitudinal observational study of hidradenitis suppurativa: impact of surgical intervention with adjunctive biologic therapy. Int J Dermatol 2018; 57:62-69. [PMID: 29130482 PMCID: PMC5760437 DOI: 10.1111/ijd.13798] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 08/16/2017] [Accepted: 09/14/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hidradenitis supppurativa (HS) is a chronic inflammatory disease of the apocrine sweat glands affecting 1-4% of the population. While surgical excision is a mainstay of therapy, lesions often recur. Biologic therapies, including tumor necrosis factor-α and IL-12/23 inhibitors, are effective for mild to moderate HS. However, longitudinal studies investigating biologic therapy in conjunction with surgery are limited. The purpose of this analysis was to investigate impact of surgery and biologic therapy on HS disease activity. METHODS Data from 68 HS patients were analyzed. Outcome measures included hidradenitis suppurativa Sartorius Score (HSS), active nodule (AN) count, Hurley stage, and probability of achieving 75% reduction in active nodule count (AN75). RESULTS Mean age was 40 ± 14 years; 66% were female and 72% were African American. Mean disease duration was 10 years, and Hurley stage III disease was seen in 63% of patients. Patients who received biologics had a larger drop in HSS and AN count than those who never received biologics (P = 0.002). Biologic treatment was associated with average reduction in 22 (15-29) HSS points (P < 0.0001). The effect of biologics was greater in patients who also underwent surgery (P = 0.013). Timing of biologics relative to surgery did not impact efficacy. Patients who received HS surgery with biologic therapy were most likely to achieve the AN75 (P = 0.017). CONCLUSIONS In this diverse cohort of patients with severe HS, biologic therapy was associated with a more rapid decline in disease activity, with the greatest effect in patients who also underwent HS surgery.
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Affiliation(s)
- Victoria K. Shanmugam
- Division of Rheumatology, Ideas to Health Laboratory, The George Washington University, School of Medicine and Health Sciences, 701 Ross Hall, 2300 Eye Street, NW, Washington, DC 20037
| | - Shaunak Mulani
- Division of Rheumatology, Ideas to Health Laboratory, The George Washington University, School of Medicine and Health Sciences, 701 Ross Hall, 2300 Eye Street, NW, Washington, DC 20037
| | - Sean McNish
- Division of Rheumatology, Ideas to Health Laboratory, The George Washington University, School of Medicine and Health Sciences, 701 Ross Hall, 2300 Eye Street, NW, Washington, DC 20037
| | - Sarah Harris
- Division of Rheumatology, Ideas to Health Laboratory, The George Washington University, School of Medicine and Health Sciences, 701 Ross Hall, 2300 Eye Street, NW, Washington, DC 20037
| | - Teresa Buescher
- Department of Plastic Surgery, The George Washington University, School of Medicine and Health Sciences, 2300 M Street NW, Washington, DC 20037
| | - Richard Amdur
- Department of Surgery, The George Washington University, School of Medicine and Health Sciences, 2150 Pennsylvania Ave. NW, Washington, DC 20037
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96
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Kuo KY, Cho HG, Sarin KY. Identification of Atorvastatin for Moderate to Severe Hidradenitis through Drug Repositioning Using Public Gene Expression Datasets. J Invest Dermatol 2017; 138:1209-1212. [PMID: 29247661 DOI: 10.1016/j.jid.2017.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 11/26/2017] [Accepted: 12/05/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Karen Y Kuo
- Department of Dermatology, Stanford University School of Medicine, Stanford, California, USA
| | - Hyunje Grace Cho
- Department of Dermatology, Stanford University School of Medicine, Stanford, California, USA
| | - Kavita Y Sarin
- Department of Dermatology, Stanford University School of Medicine, Stanford, California, USA.
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97
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Theut Riis P, Thorlacius LR, Jemec GB. Investigational drugs in clinical trials for Hidradenitis Suppurativa. Expert Opin Investig Drugs 2017; 27:43-53. [PMID: 29188733 DOI: 10.1080/13543784.2018.1412430] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Hidradenitis suppurativa is a chronic skin disease with a significant unmet need for treatment options. Randomized controlled trials are few and only a single drug (adalimumab) has Hidradenitis as a registered indication. AREAS COVERED The clinicaltrials.gov and the EudraCT clinical trials register for reported trials on Hidradenitis Suppurativa was searched on the 22-06-2017. Trials for upcoming new drugs for HS are reported focusing on drugs in phase I and II trials.The clinicaltrials.gov and the EudraCT clinical trials register for reported trials on Hidradenitis Suppurativa was searched on the 22-06-2017. Trials for upcoming new drugs for HS are reported focusing on drugs in phase I and II trials. EXPERT OPINION Currently, MABp1, Secukinumab, CJM112, Apremilast and IFX-1 are being investigated in Phase I and II trials and offer theoretical and promising new treatment options. A trial with the drug MEDI8968 has been terminated with disappointing results. Metformin, Botulinum Toxin B, Provodine, Benzoyl Peroxide and intralesional triamcinolone are being tested as well. Treatment of Hidradenitis remains a challenge and quality RTCs are needed. Studies indicates a range of potential targets for therapy such as interleukin-1 and interleukin-17, but 'broad-spectrum' immunosuppressants like phosphodiesterase-4 inhibitors are being examined as well. A range of outcomes, including Physician Global Assessment, Sartorius scores and hidradenitis suppurativa clinical response are used in these trials, making future meta-analysis of the data difficult.
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Affiliation(s)
- Peter Theut Riis
- a Department of Dermatology , University Hospital Zealand , Roskilde , Denmark.,b Health Sciences Faculty , University of Copenhagen , Copenhagen , Denmark
| | - Linnea R Thorlacius
- a Department of Dermatology , University Hospital Zealand , Roskilde , Denmark.,b Health Sciences Faculty , University of Copenhagen , Copenhagen , Denmark
| | - Gregor B Jemec
- a Department of Dermatology , University Hospital Zealand , Roskilde , Denmark.,b Health Sciences Faculty , University of Copenhagen , Copenhagen , Denmark
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98
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Sabat R, Tsaousi A, Rossbacher J, Kurzen H, Fadai T, Schwichtenberg U, Schneider-Burrus S, Kokolakis G, Wolk K. [Acne inversa/hidradenitis suppurativa: An update]. DER HAUTARZT 2017; 68:999-1006. [PMID: 29159469 DOI: 10.1007/s00105-017-4082-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Acne inversa (AI)/hidradenitis suppurativa is a chronic, recurrent, immune-mediated dermatosis characterized by deep inflammatory nodules, abscesses, fistulas, and undermined scars in skin areas bearing apocrine glands. In addition to the cutaneous manifestation, numerous AI patients show metabolic changes, spondyloarthritis, and depression. AI leads to a strong reduction in the quality of life and an impairment of the sexual life of affected individuals and often culminates in social withdrawal, stigmatization, unemployment, and suicidal thoughts. In this overview, we summarized the most important facts about AI and propose a simple algorithm for therapy.
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Affiliation(s)
- R Sabat
- Interdisziplinäre Gruppe Molekulare Immunpathologie, Dermatologie/Med. Immunologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.
- Psoriasis Forschungs- und BehandlungsCentrum, Klinik für Dermatologie, Venerologie und Allergologie und Institut für Medizinische Immunologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - A Tsaousi
- Interdisziplinäre Gruppe Molekulare Immunpathologie, Dermatologie/Med. Immunologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
- Psoriasis Forschungs- und BehandlungsCentrum, Klinik für Dermatologie, Venerologie und Allergologie und Institut für Medizinische Immunologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | | | - H Kurzen
- Haut- und Laserzentrum Freising, Freising, Deutschland
| | - T Fadai
- Hautarztpraxis, Bremen, Deutschland
| | | | - S Schneider-Burrus
- Interdisziplinäre Gruppe Molekulare Immunpathologie, Dermatologie/Med. Immunologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
- Zentrum für Dermatochirurgie, Havelklinik, Berlin, Deutschland
| | - G Kokolakis
- Interdisziplinäre Gruppe Molekulare Immunpathologie, Dermatologie/Med. Immunologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
- Psoriasis Forschungs- und BehandlungsCentrum, Klinik für Dermatologie, Venerologie und Allergologie und Institut für Medizinische Immunologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - K Wolk
- Interdisziplinäre Gruppe Molekulare Immunpathologie, Dermatologie/Med. Immunologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
- Psoriasis Forschungs- und BehandlungsCentrum, Klinik für Dermatologie, Venerologie und Allergologie und Institut für Medizinische Immunologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
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99
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Kanni T, Argyropoulou M, Spyridopoulos T, Pistiki A, Stecher M, Dinarello CA, Simard J, Giamarellos-Bourboulis EJ. MABp1 Targeting IL-1α for Moderate to Severe Hidradenitis Suppurativa Not Eligible for Adalimumab: A Randomized Study. J Invest Dermatol 2017; 138:795-801. [PMID: 29129600 DOI: 10.1016/j.jid.2017.10.030] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 10/25/2017] [Accepted: 10/26/2017] [Indexed: 01/05/2023]
Abstract
Patients with moderate to severe hidradenitis suppurativa failing adalimumab therapy, or those ineligible to receive it, remain a population with an unmet need. Twenty patients not eligible for adalimumab were randomized to receive 12 weeks of blind treatment with placebo or MABp1, a true human antibody targeting IL-1α. Hidradenitis suppurativa clinical response score at week 12 was the primary endpoint. The primary endpoint was met in 10% and 60% of placebo- and MABp1-treated patients, respectively (odds ratio = 13.50, 95% confidence interval = 1.19-152.51). Clinical efficacy was maintained at 24 weeks in 0% and 40%. Improvement in the visual analog scale was reported by 20% and 85.7%, respectively, of patients failing previous anti-TNF treatment. Ultrasonography showed decreased neovascularization and lesion skin depth in the MABp1 group. MABp1 treatment was associated with decrease of circulating IL-8 and of stimulated production of IL-8 by whole blood. Whole blood production for hBD-2 was negatively associated with changes on ultrasonography in the placebo group but not in the MABp1 group. MABp1 is a promising treatment for patients with hidradenitis suppurativa not eligible for adalimumab. Inhibition of neovascularization and modulation of the production of IL-8 and hBD-2 are suggested mechanisms of action.
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Affiliation(s)
- Theodora Kanni
- Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Greece
| | - Maria Argyropoulou
- Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Greece
| | - Themistoklis Spyridopoulos
- Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Greece
| | - Aikaterini Pistiki
- Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Greece
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100
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Zouboulis CC, Tzellos T, Kyrgidis A, Jemec GBE, Bechara FG, Giamarellos-Bourboulis EJ, Ingram JR, Kanni T, Karagiannidis I, Martorell A, Matusiak Ł, Pinter A, Prens EP, Presser D, Schneider-Burrus S, von Stebut E, Szepietowski JC, van der Zee HH, Wilden SM, Sabat R. Development and validation of the International Hidradenitis Suppurativa Severity Score System (IHS4), a novel dynamic scoring system to assess HS severity. Br J Dermatol 2017. [PMID: 28636793 DOI: 10.1111/bjd.15748] [Citation(s) in RCA: 264] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND A validated tool for the dynamic severity assessment of hidradenitis suppurativa/acne inversa (HS) is lacking. OBJECTIVES To develop and validate a novel dynamic scoring system to assess the severity of HS. METHODS A Delphi voting procedure was conducted among the members of the European Hidradenitis Suppurativa Foundation (EHSF) to achieve consensus towards an initial HS Severity Score System (HS4). Strengths and weaknesses of HS4 were examined by a multicentre prospective study. Multivariate logistic regression, discriminant analysis and receiver operating characteristic curves, as well as examination for correlation (Spearman's rho) and agreement (Cohen's kappa) with existing scores, were engaged to recognize the variables for a new International HS4 (IHS4) that was established by a second Delphi round. RESULTS Consensus HS4 was based on number of skin lesions, number of skin areas involved and Dermatology Life Quality Index (DLQI), and was evaluated by a sample of 236 patients from 11 centres. Subsequently, a multivariate regression model calculated adjusted odds ratios for several clinical signs. Nodules, abscesses and draining tunnels resulted as the scoring variables. Three candidate scores were presented to the second Delphi round. The resulting IHS4 score is arrived at by the number of nodules (multiplied by 1) plus the number of abscesses (multiplied by 2) plus the number of draining tunnels (multiplied by 4). A total score of 3 or less signifies mild, 4-10 signifies moderate and 11 or higher signifies severe disease. Cohen's kappa was fair (κ = 0·32) compared with Hurley classification, and moderate (κ = 0·49) compared with Expert Opinion. Correlation was good (ρ > 0·6) with Hurley classification, Expert Opinion, Physician's Global Assessment and Modified Sartorius score, and moderate for DLQI (ρ = 0·36). CONCLUSIONS The novel IHS4 is a validated tool to dynamically assess HS severity and can be used both in real-life and the clinical trials setting.
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Affiliation(s)
- C C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Centre, Brandenburg Medical School Theodor Fontane, Dessau, Germany.,Division of Evidence Based Dermatology, Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Centre, Brandenburg Medical School Theodor Fontane, University of Brandenburg, Dessau, Germany
| | - T Tzellos
- Department of Dermatology, Faculty of Health Sciences, University Hospital of North Norway, Harstad, Troms, Norway
| | - A Kyrgidis
- Division of Evidence Based Dermatology, Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Centre, Brandenburg Medical School Theodor Fontane, University of Brandenburg, Dessau, Germany
| | - G B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - F G Bechara
- Department of Dermatology, Venereology and Allergology, Ruhr University Bochum, Bochum, Germany
| | - E J Giamarellos-Bourboulis
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - J R Ingram
- Department of Dermatology and Academic Wound Healing, Division of Infection and Immunity, Cardiff University, Cardiff, U.K
| | - T Kanni
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - I Karagiannidis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Centre, Brandenburg Medical School Theodor Fontane, Dessau, Germany
| | - A Martorell
- Department of Dermatology, Hospital de Manises, Valencia, Spain
| | - Ł Matusiak
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wrocław, Poland
| | - A Pinter
- Department of Dermatology, Venereology and Allergology, Goethe University of Frankfurt, Frankfurt am Main, Germany
| | - E P Prens
- Department of Dermatology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - D Presser
- Department of Dermatology, Venereology and Allergology, University Hospital of Würzburg, Würzburg, Germany
| | - S Schneider-Burrus
- Interdisciplinary Group of Molecular Immunopathology, Dermatology/Medical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Centre of Vein and Skin Surgery, Havelkinik Berlin, Berlin, Germany
| | - E von Stebut
- Department of Dermatology, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany
| | - J C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wrocław, Poland
| | - H H van der Zee
- Department of Dermatology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - S M Wilden
- Department of Dermatology, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany
| | - R Sabat
- Interdisciplinary Group of Molecular Immunopathology, Dermatology/Medical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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