1
|
Kimball AB, Podda M, Alavi A, Miller M, Shen YK, Li S, Xu Y, Han C, Fakharzadeh S, Yang YW, DePrimo S, Munoz E, Chen Y, Passeron T, Papp K. Guselkumab for the treatment of patients with moderate-to-severe hidradenitis suppurativa: A phase 2 randomized study. J Eur Acad Dermatol Venereol 2023; 37:2098-2108. [PMID: 37317022 DOI: 10.1111/jdv.19252] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/10/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that causes substantial physical, emotional and psychological burdens. Guselkumab, a monoclonal antibody that binds to the p19 subunit of interleukin-23, has demonstrated high levels of efficacy in the treatment of inflammatory diseases, including psoriasis and psoriatic arthritis. OBJECTIVE To evaluate the effect of guselkumab on the treatment of HS, a phase 2, multicentre, randomized, placebo-controlled, double-blind, proof-of-concept study was conducted. METHODS Patients ≥18 years of age with moderate-to-severe HS for ≥1 year were randomized to (1) guselkumab 200 mg by subcutaneous (SC) injection every 4 weeks (q4w) through Week 36 (guselkumab SC); (2) guselkumab 1200 mg intravenously (IV) q4w for 12 weeks, then switched to guselkumab 200 mg SC q4w from Weeks 12 through 36 (guselkumab IV); or (3) placebo for 12 weeks, with re-randomization to guselkumab 200 mg SC q4w at Weeks 16 through 36 (placebo → guselkumab 200 mg) or guselkumab 100 mg SC at Weeks 16, 20, 28 and 36 and placebo at Weeks 24 and 32 (placebo → guselkumab 100 mg). End points included HS clinical response (HiSCR) and patient-reported outcomes. RESULTS Although guselkumab SC or guselkumab IV resulted in numerically higher HiSCR versus placebo at Week 16 (50.8%, 45.0%, 38.7%, respectively), statistical significance was not achieved. Numerically greater improvements in patient-reported outcomes were also observed for guselkumab SC and guselkumab IV versus placebo at Week 16. Through Week 40, no clear differences to suggest a dose response were observed for HiSCR and patient-reported outcomes. CONCLUSIONS Despite modest improvements, the primary end point was not met and the overall findings do not support the efficacy of guselkumab in the treatment of HS. CLINICALTRIALS gov: NCT03628924.
Collapse
Affiliation(s)
- Alexa B Kimball
- Department of Dermatology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Maurizio Podda
- Department of Dermatology, Medical Center Klinikum Darmstadt, Teaching Hospital Goethe-University Frankfurt, Darmstadt, Germany
| | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Megan Miller
- Janssen Research & Development, LLC, Spring House, Pennsylvania, USA
| | - Yaung-Kaung Shen
- Janssen Research & Development, LLC, Spring House, Pennsylvania, USA
| | - Shu Li
- Janssen Research & Development, LLC, Spring House, Pennsylvania, USA
| | - Yan Xu
- Janssen Research & Development, LLC, Spring House, Pennsylvania, USA
| | - Chenglong Han
- Patient-Reported Outcomes, Janssen Global Services, LLC, Malvern, Pennsylvania, USA
| | - Steven Fakharzadeh
- Immunology Global Medical Affairs, Janssen Pharmaceutical Companies of Johnson & Johnson, Horsham, Pennsylvania, USA
| | - Ya-Wen Yang
- Immunology Global Medical Affairs, Janssen Pharmaceutical Companies of Johnson & Johnson, Horsham, Pennsylvania, USA
| | | | | | - Yanqing Chen
- Janssen Research & Development, LLC, Spring House, Pennsylvania, USA
| | - Thierry Passeron
- Department of Dermatology, CHU Nice, Cote d'Azur University, Nice, France
- C3M, INSERM U1065, Cote d'Azur University, Nice, France
| | - Kim Papp
- Alliance Clinical Trials and Probity Medical Research, Inc, Waterloo, Ontario, Canada
| |
Collapse
|
2
|
Melgosa Ramos FJ, García-Ruiz R, Gegúndez Hernández H, Mateu-Puchades A. Real-Life Experience of Secukinumab in Patients With Hidradenitis Suppurativa. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:T360-T362. [PMID: 36764387 DOI: 10.1016/j.ad.2022.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 03/06/2022] [Indexed: 02/11/2023] Open
Affiliation(s)
- F J Melgosa Ramos
- Departamento de Dermatología, Hospital Universitario Doctor Peset, Valencia, España.
| | - R García-Ruiz
- Departamento de Dermatología, Hospital Universitario Doctor Peset, Valencia, España
| | - H Gegúndez Hernández
- Departamento de Dermatología, Hospital Universitario Doctor Peset, Valencia, España
| | - A Mateu-Puchades
- Departamento de Dermatología, Hospital Universitario Doctor Peset, Valencia, España
| |
Collapse
|
3
|
Schneider-Burrus S, Kalus S, Fritz B, Wolk K, Gomis-Kleindienst S, Sabat R. The impact of hidradenitis suppurativa on professional life. Br J Dermatol 2023; 188:122-130. [PMID: 36689513 DOI: 10.1093/bjd/ljac027] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/19/2022] [Accepted: 09/24/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory disease that affects intertriginous skin. OBJECTIVES To determine the extent of work ability and productivity impairment as a result of HS in Germany. METHODS A prospective, multicentre, epidemiological, noninterventional study of patients with HS was conducted. Medical history, medical examination performed by dermatologists and patient-reported outcomes [Work Ability Index (WAI) and Work Productivity and Activity Impairment (WPAI)] were collected. RESULTS Of the 481 patients with HS included in the study, 99% were below the current statutory retirement age. In total, 53·3% of patients were working full time, 16·8% part time and 7·3% had retired. The unemployment rate was 12·6%, two times higher than in the general German population. Medical leave because of HS, within the last 6 months, was reported in 41·4% [95% confidence interval (CI) 36·9-46·0], with a duration of 39·3 days on average (95% CI 32·4-46·1). The mean HS-related WPAI absenteeism was 13.3% (95% CI 9·7-16·8), and the loss in productivity because of HS during working hours (WPAI presenteeism) was 25.2% (95% CI 21·8-28·6). Presenteeism was associated with HS disease severity. Overall work impairment because of HS was 33·4% (95% CI 29·3-37·6). The WAI score for patients was 32·2, ∼20% lower than for the average German employee. Only 62·8% of patients were relatively certain that they would be able to perform their work in the coming 2 years. Being more depressed and having more severe pain were associated with lower work ability and overall work impairment. The estimated annual loss of gross value added because of HS for Germany was ∼€12.6 billion (€3.3 billion related to a lower employment rate, €3.5 billion related to absenteeism and €5.8 billion related to presenteeism). CONCLUSIONS HS leads to a substantial decrease in work ability and productivity and considerable loss of gross value added. Impairment during working hours correlates with disease severity, underlining the socioeconomic importance of early and adequate treatment. Furthermore, decreased work ability and productivity is linked to depressed mood and severe pain, aspects that need more attention in patient care.
Collapse
Affiliation(s)
- Sylke Schneider-Burrus
- Interdisciplinary Group of Molecular Immunopathology, Dermatology/Medical Immunology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Centre for Dermatosurgery, Havelklinik, Gatower Str. 191, 13595 Berlin, Germany
| | - Stefanie Kalus
- GKM Gesellschaft für Therapieforschung mbH, Lessingstraße 14, 80336 Munich, Germany
| | - Björn Fritz
- AbbVie Deutschland GmbH & Co. KG, Mainzer Straße 81, 65189 Wiesbaden, Germany
| | - Kerstin Wolk
- Interdisciplinary Group of Molecular Immunopathology, Dermatology/Medical Immunology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Psoriasis Research and Treatment Centre, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | | | - Robert Sabat
- Interdisciplinary Group of Molecular Immunopathology, Dermatology/Medical Immunology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Psoriasis Research and Treatment Centre, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| |
Collapse
|
4
|
Melgosa Ramos FJ, García-Ruiz R, Gegúndez Hernández H, Mateu-Puchades A. Real-Life Experience of Secukinumab in Patients With Hidradenitis Suppurativa. ACTAS DERMO-SIFILIOGRAFICAS 2022; 114:360-362. [PMID: 36529272 DOI: 10.1016/j.ad.2022.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 03/06/2022] [Indexed: 12/23/2022] Open
Affiliation(s)
- F J Melgosa Ramos
- Department of dermatology, University Hospital Doctor Peset of Valencia, Spain.
| | - R García-Ruiz
- Department of dermatology, University Hospital Doctor Peset of Valencia, Spain
| | | | - A Mateu-Puchades
- Department of dermatology, University Hospital Doctor Peset of Valencia, Spain
| |
Collapse
|
5
|
Agud‐Dios M, Arroyo‐Andrés J, Rubio‐Muñiz C, Postigo‐Lorente C. Successful treatment of hidradenitis suppurativa and Crohn's disease with combined guselkumab and apremilast. Dermatol Ther 2022; 35:e15743. [PMID: 35904888 PMCID: PMC9787683 DOI: 10.1111/dth.15743] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 12/30/2022]
Affiliation(s)
- Manuel Agud‐Dios
- Department of DermatologyHospital Universitario 12 de OctubreMadridSpain
| | | | - Carmen Rubio‐Muñiz
- Department of DermatologyHospital Universitario 12 de OctubreMadridSpain
| | | |
Collapse
|
6
|
Similar Levels of Efficacy of Two Different Maintenance Doses of Adalimumab on Clinical Severity and Quality of Life of Patients with Hidradenitis Suppurativa. J Clin Med 2022; 11:jcm11144037. [PMID: 35887799 PMCID: PMC9318217 DOI: 10.3390/jcm11144037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/04/2022] [Accepted: 07/06/2022] [Indexed: 02/04/2023] Open
Abstract
Adalimumab is the only biologic agent approved for the treatment of moderate-to-severe hidradenitis suppurativa (HS) patients (i.e., with Hurley II or III), which is recommended in two different maintenance doses (i.e., 40 mg weekly or 80 mg every two weeks). We conducted a prospective multicentric study to measure outcomes related to the severity of disease and quality of life (QoL) of patients affected by moderate-to-severe HS, treated with adalimumab at a maintenance dosing of 40 mg or 80 mg. Assessments were performed at baseline (T0) and after 32 weeks of treatment (T32). We enrolled 85 moderate-to-severe HS Italian patients, 43 men (50.6%) and 42 women, aged between 16 and 62 years (median 31 years, interquartile range 24.4–43.8). Statistically significant improvements were observed for clinical status (with a mean reduction of 7.1 points for the International Hidradenitis Suppurativa Severity Score System (IHS4)), pain levels (3.1 mean decrease in VAS), and QoL (3.4 mean improvement in DLQI score). Patients with no comorbidities, and those with higher levels of perceived pain showed significantly greater improvement in QoL than their counterpart from T0 to T32. As for the proportion of patients who at follow-up reached the minimal clinical important difference (MCID) in QoL, significantly higher proportions of success were observed for age (patients in the 29–39 category), pain (patients with higher reported pain), and Hurley stage III. While both treatment regimen groups (i.e., 40 vs. 80 mg) improved significantly, no statistical differences were observed when comparing the two treatment dosages.
Collapse
|
7
|
Off-Label Use of Botulinum Toxin in Dermatology—Current State of the Art. Molecules 2022; 27:molecules27103143. [PMID: 35630620 PMCID: PMC9147387 DOI: 10.3390/molecules27103143] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 01/01/2023] Open
Abstract
Botulinum toxin (BoNT) is a neurotoxin produced by the Clostridium botulinum bacteria. Among seven different isoforms, only BoNT-A and BoNT-B are commercially used. Currently, botulinum toxin has been indicated by the U.S. Food and Drug Administration in several disorders, among others: chronic migraine, hyperhidrosis, urinary incontinence from detrusor overactivity, or cosmetics. However, there are numerous promising reports based on off-label BTX usage, indicating its potential effectiveness in other diseases, which remains unknown to many. Among them, dermatological conditions, such as rosacea, annal fissure, Raynaud phenomenon, hypertrophic scars and keloids, and also hidradenitis suppurativa, are currently being investigated. This article aims to provide a comprehensive update on the off-label use of botulinum toxin in dermatology, based on an analysis and summary of the published literature.
Collapse
|
8
|
Melgosa Ramos FJ, García Ruiz R, Mateu Puchades A, Alfageme Roldán F. Guselkumab Effectiveness, and Posology in Patients With Moderate to Severe Hidradenitis Suppurativa: A Retrospective Bicentric Experience. Dermatol Ther 2022; 35:e15558. [PMID: 35510581 DOI: 10.1111/dth.15558] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/07/2022] [Accepted: 05/03/2022] [Indexed: 11/26/2022]
Abstract
Hidradenitis suppurativa (HS) is a chronic, inflammatory, and recalcitrant skin disease of the terminal hair follicle. Therapeutic alternatives in HS are limited nowadays. Adalimumab, is the only approved biological treatment for patients with moderate to severe HS, and some patients do not reach an optimal response, or experience a progressive response loss, needing therapeutic alternatives. IL-23 pathway is also involved in HS pathogenesis, so its blockade could contribute to reach disease control. Guselkumab is a monoclonal antibody targeting the p19 subunit of extracellular IL-23, currently approved for psoriasis in adults, and recently some authors have reported its effectiveness in patients with moderate to severe HS refractory to other systemic treatments, becoming a hope for some patients. However adequate dosing and intervals have not been determined yet, so in most published series, doses approved for psoriasis are commonly used. On this topic a retrospective bicentric study including HS patients treated with guselkumab in the dermatologic departments of university hospitals Puerta de Hierro of Majadahonda (Madrid, Spain) and Doctor Peset of Valencia (Valencia, Spain) was conducted. We reported effectiveness, dosage and frequency of administration in the cohort, in order to establish the most effective dosage regimen and to clarify the potential role of guselkumab for this disease. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- F J Melgosa Ramos
- Department of dermatology, University Hospital Doctor Peset of Valencia, Valencia, Spain
| | - R García Ruiz
- Department of dermatology, University Hospital Doctor Peset of Valencia, Valencia, Spain
| | - A Mateu Puchades
- Department of dermatology, University Hospital Doctor Peset of Valencia, Valencia, Spain
| | - F Alfageme Roldán
- Department of dermatology, University Hospital Puerta de Hierro of Majadahonda, Madrid, Spain
| |
Collapse
|
9
|
Lewandowski M, Świerczewska Z, Barańska‐Rybak W. Hidradenitis suppurativa: a review of current treatment options. Int J Dermatol 2022; 61:1152-1164. [DOI: 10.1111/ijd.16115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 01/09/2022] [Accepted: 01/09/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Miłosz Lewandowski
- Department of Dermatology, Venereology and Allergology Medical University of Gdansk Gdansk Poland
| | - Zuzanna Świerczewska
- Department of Dermatology, Venereology and Allergology Medical University of Gdansk Gdansk Poland
| | - Wioletta Barańska‐Rybak
- Department of Dermatology, Venereology and Allergology Medical University of Gdansk Gdansk Poland
| |
Collapse
|
10
|
Bató A, Brodszky V, Gergely LH, Gáspár K, Wikonkál N, Kinyó Á, Szabó Á, Beretzky Z, Szegedi A, Remenyik É, Kiss N, Sárdy M, Rencz F. The measurement performance of the EQ-5D-5L versus EQ-5D-3L in patients with hidradenitis suppurativa. Qual Life Res 2021; 30:1477-1490. [PMID: 33534032 PMCID: PMC8068690 DOI: 10.1007/s11136-020-02732-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease that affects up to 1% of the population in Europe. The EQ-5D is the most commonly used generic instrument for measuring health-related quality of life among HS patients. This study aims to compare the measurement properties of the two adult versions of EQ-5D (EQ-5D-3L and EQ-5D-5L) in patients with HS. METHODS We recruited 200 consecutive patients with HS (mean age 37 years, 38% severe or very severe HS) to participate in a multicentre cross-sectional survey. Patients completed the EQ-5D-3L, EQ-5D-5L, Dermatology Life Quality Index (DLQI) and Skindex-16 questionnaires. RESULTS More than twice as many different health state profiles occurred in the EQ-5D-5L compared to the EQ-5D-3L (101 vs. 43). A significant reduction in ceiling effect was found for the mobility, self-care and usual activities dimensions. A good agreement was established between the EQ-5D-3L and EQ-5D-5L with an intraclass correlation coefficient of 0.872 (95% CI 0.830-0.903; p < 0.001) that was confirmed by a Bland-Altman plot. EQ-5D-5L improved both the absolute and relative informativity in all dimensions except for anxiety/depression. EQ-5D-3L and EQ-5D-5L demonstrated similar convergent validity with DLQI and Skindex-16. EQ-5D-5L was able to better discriminate between known groups of patients based on the number of comorbidities and disease severity (HS-Physician's Global Assessment). CONCLUSION In patients with HS, the EQ-5D-5L outperformed the EQ-5D-3L in feasibility, ceiling effects, informativity and known-groups validity for many important clinical characteristics. We recommend using the EQ-5D-5L in HS patients across various settings, including clinical care, research and economic evaluations.
Collapse
Affiliation(s)
- Alex Bató
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, H-1093, Budapest, Hungary
- Károly Rácz Doctoral School of Clinical Medicine, Semmelweis University, Üllői út 26, H-1085, Budapest, Hungary
| | - Valentin Brodszky
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, H-1093, Budapest, Hungary.
| | - L Hunor Gergely
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, Mária u. 41, H-1085, Budapest, Hungary
| | - Krisztián Gáspár
- Faculty of Medicine, Departments of Dermatology, University of Debrecen, Nagyerdei krt. 98, H-4032, Debrecen, Hungary
- Faculty of Medicine, Department of Dermatological Allergology, University of Debrecen, Nagyerdei krt. 98, H-4032, Debrecen, Hungary
| | - Norbert Wikonkál
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, Mária u. 41, H-1085, Budapest, Hungary
| | - Ágnes Kinyó
- University of Pécs Medical School Department of Dermatology, Venereology and Oncodermatology, Akác utca 1, H-7632, Pécs, Hungary
| | - Ákos Szabó
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, H-1093, Budapest, Hungary
- Károly Rácz Doctoral School of Clinical Medicine, Semmelweis University, Üllői út 26, H-1085, Budapest, Hungary
| | - Zsuzsanna Beretzky
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, H-1093, Budapest, Hungary
| | - Andrea Szegedi
- Faculty of Medicine, Departments of Dermatology, University of Debrecen, Nagyerdei krt. 98, H-4032, Debrecen, Hungary
- Faculty of Medicine, Department of Dermatological Allergology, University of Debrecen, Nagyerdei krt. 98, H-4032, Debrecen, Hungary
| | - Éva Remenyik
- Faculty of Medicine, Departments of Dermatology, University of Debrecen, Nagyerdei krt. 98, H-4032, Debrecen, Hungary
| | - Norbert Kiss
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, Mária u. 41, H-1085, Budapest, Hungary
| | - Miklós Sárdy
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, Mária u. 41, H-1085, Budapest, Hungary
| | - Fanni Rencz
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, H-1093, Budapest, Hungary
- Premium Postdoctoral Research Programme, Hungarian Academy of Sciences, Nádor u. 7, H-1051, Budapest, Hungary
| |
Collapse
|
11
|
Pinter A, Sarlak M, Zeiner KN, Malisiewicz B, Kaufmann R, Romanelli M, Koenig A, Chiricozzi A. Coprevalence of Hidradenitis Suppurativa and Psoriasis: Detailed Demographic, Disease Severity and Comorbidity Pattern. Dermatology 2020; 237:759-768. [PMID: 33326954 DOI: 10.1159/000511868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/30/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Hidradenitis suppurativa (HS) and plaque psoriasis (Pso) are supposed to have a coprevalence. However, data showing a more detailed description of patients with both diseases are rare. In this study, we characterized patients with both skin diseases in terms of onset, disease course, severity, concomitant diseases and therapeutical management. PATIENTS AND METHODS Data from 28 patients with a confirmed codiagnosis of HS and Pso from 2 university hospitals presented between 2015 and 2019 were evaluated retrospectively. For further characterization, patients were divided into different cohorts depending on whether HS or Pso was diagnosed as the first disease. RESULTS The average age of patients with a coprevalence of both diseases was 44.4 years with a female/male ratio of 1:1.15. Fifteen patients were diagnosed first with HS at an average age of 22.8 years, 13 patients first showed symptoms of Pso at a mean age of 21.7 years. The average time to the onset of the corresponding second disease was 14.3 years. Patients with HS as first disease showed a significantly severer form of HS compared to patients with a first diagnosis of Pso (mean highest International Hidradenitis Suppurativa Severity Score System: 23.5 vs. 8.2; p = 0.02). Severity of psoriatic disease in patients with HS at first diagnosis was numerically lower but not significant compared to the cohort with Pso at first diagnosis (mean highest Psoriasis Area and Severity Index: 7.8 vs. 13.2; p = 0.299). The most frequent comorbidity in all patients was obesity (64.3%; mean body mass index: 32.2) followed by psychiatric complaints (25%) and psoriatic arthritis (21.4%). Adalimumab was the most commonly used drug that had a positive effect on both diseases, HS and Pso. CONCLUSIONS In patients with a coprevalence of HS and Pso, the disease which occurs first appears to take a severer course, with an increased risk of development of obesity and psychiatric comorbidity in both cohorts.
Collapse
Affiliation(s)
- Andreas Pinter
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Frankfurt am Main, Germany,
| | - Mana Sarlak
- Department of Dermatology, Hospital Darmstadt, Darmstadt, Germany
| | - Kim Nicola Zeiner
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Bartosz Malisiewicz
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Roland Kaufmann
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Marco Romanelli
- Dermatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Anke Koenig
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Andrea Chiricozzi
- Dermatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Institute of Dermatology, Catholic University, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| |
Collapse
|
12
|
Jørgensen AR, Holm JG, Thomsen SF. Guselkumab for hidradenitis suppurativa in a patient with concomitant Crohn's disease: Report and systematic literature review of effectiveness and safety. Clin Case Rep 2020; 8:2874-2877. [PMID: 33363841 PMCID: PMC7752321 DOI: 10.1002/ccr3.3090] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/20/2020] [Accepted: 06/26/2020] [Indexed: 12/26/2022] Open
Abstract
Guselkumab appears to be safe and effective in the treatment of patients with HS, who do not respond to adalimumab and other systemic therapies. Guselkumab can be used in patients with comorbid Crohn's disease.
Collapse
Affiliation(s)
| | - Jesper Grønlund Holm
- Department of Dermato‐Venereology & Wound Healing CentreBispebjerg HospitalCopenhagenDenmark
| | - Simon Francis Thomsen
- Department of Dermato‐Venereology & Wound Healing CentreBispebjerg HospitalCopenhagenDenmark
- Department of Biomedical SciencesUniversity of CopenhagenCopenhagenDenmark
| |
Collapse
|
13
|
Willems D, Charokopou M, Evers SMAA, Hiligsmann M. Early health economic modelling for a treatment candidate in hidradenitis suppurativa. J Med Econ 2020; 23:1516-1524. [PMID: 33084453 DOI: 10.1080/13696998.2020.1840181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AIMS Hidradenitis suppurativa (HS) is a chronic skin condition causing inflammatory lesions, pain, scarring, and impaired mobility. Treatment options are limited and often lack success implying the need for additional/improved treatments. This research aimed to estimate the potential economic value of a treatment candidate, explore drivers of cost-effectiveness, and highlight economic evidence requirements for successful future value assessments. MATERIALS AND METHODS An early cost-effectiveness model was developed to assess the cost-effectiveness (cost per quality-adjusted life year (QALY) gained) of a treatment candidate compared against the only authorized biologic, adalimumab, for moderate to severe HS, from a UK National Health Service and Personal Social Service perspective. A targeted literature review of clinical and economic references and previous health technology assessments (HTA) was performed for development and validation of the early economic model used to present sensitivity analyses accompanying the base case cost-effectiveness results. RESULTS AND LIMITATIONS Base case results revealed the candidate not to be cost-effective compared to adalimumab when considering a formal cost-effectiveness threshold of £30,000 per QALY gained. Scenario- and threshold analyses highlighted that reducing dosing or drug price by half improved the cost-effectiveness of the candidate. Cost-effectiveness was highly sensitive to health states' utility values, treatment discontinuation, and resource utilization, in line with existing HTA evidence. The paucity of economic studies and uncertainties around the candidate presented methodological constraints that were addressed through sensitivity analyses. CONCLUSIONS Key costs and health effects drivers were highlighted to contextualize under which circumstances a treatment candidate for moderate to severe HS would reach acceptable cost-effectiveness levels. This early economic evaluation suggested promising economic perspectives for treatment candidates in HS. Exploring novel ways to use clinical endpoints to simulate the patient pathway and clinically meaningful treatment achievements in future research will facilitate the value demonstration of candidates in disease areas with high unmet care need.
Collapse
Affiliation(s)
- Damon Willems
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- UCB Pharma, Brussels, Belgium
| | | | - Silvia M A A Evers
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Mickaël Hiligsmann
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
14
|
Bieber T. Novel therapies based on the pathophysiology of atopic dermatitis. J Dtsch Dermatol Ges 2020; 17:1150-1162. [PMID: 31765104 DOI: 10.1111/ddg.13965] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 09/17/2019] [Indexed: 12/26/2022]
Abstract
Our understanding of the mechanisms underlying atopic dermatitis has been instrumental in the development of novel pharmacological agents. Worldwide, more than seventy companies are currently developing at least one new drug for the treatment of atopic dermatitis. Based on our current understanding of the pathophysiology of the disease, the present review article highlights the most important novel therapeutic strategies.
Collapse
Affiliation(s)
- Thomas Bieber
- Department of Dermatology and Allergology, University Medical Center, Rheinische Friedrich Wilhelms University, Bonn, Germany
| |
Collapse
|
15
|
Głowaczewska A, Szepietowski JC, Matusiak Ł. Severe hidradenitis suppurativa successfully treated with secukinumab. Dermatol Ther 2020; 33:e13845. [DOI: 10.1111/dth.13845] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/01/2020] [Accepted: 06/06/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Amelia Głowaczewska
- Department of Dermatology, Venereology and Allergology Wroclaw Medical University Wroclaw Poland
| | - Jacek C. Szepietowski
- Department of Dermatology, Venereology and Allergology Wroclaw Medical University Wroclaw Poland
| | - Łukasz Matusiak
- Department of Dermatology, Venereology and Allergology Wroclaw Medical University Wroclaw Poland
| |
Collapse
|
16
|
Nomura T. Hidradenitis Suppurativa as a Potential Subtype of Autoinflammatory Keratinization Disease. Front Immunol 2020; 11:847. [PMID: 32508815 PMCID: PMC7251184 DOI: 10.3389/fimmu.2020.00847] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 04/14/2020] [Indexed: 12/11/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition, clinically characterized by boiled cysts, comedones, abscesses, hypertrophic scars, and/or sinus tracts typically in the apocrine-gland-rich areas such as the axillae, groin, and/or buttocks. Although its precise pathogenic mechanisms remain unknown, I herein emphasize the importance of the following three recent discoveries in the pathogenesis of HS: First, heterozygous loss-of-function mutations in the genes encoding γ-secretase, including NCSTN, PSENEN, and PSEN1, have been identified in some patients with HS. Such genetic alterations result in hyperkeratosis, dysregulated hair follicle differentiation, and cyst formation via aberrant Notch signaling. Furthermore, Psen1-/Psen2-, Psen1-, Ncstn+/-, and Notch1-/Notch2- mice share common phenotypes of human HS, suggesting a role of aberrant keratinization in the development of HS. Second, upregulation of interleukin 1β, interleukin-36, caspase-1, and NLRP3 and dysregulation of the Th17:Treg cell axis have been demonstrated in HS samples, suggesting that autoinflammation is a key event in the pathophysiology of the disease. Notably, HS may be complicated with other autoinflammatory diseases such as inflammatory bowel diseases and pyoderma gangrenosum, again highlighting the importance of autoinflammation in HS. Last, biologics such as adalimumab, infliximab, anakinra, ustekinumab, and secukinumab are reportedly effective for moderate-to-severe HS. These findings collectively suggest that HS is closely linked with aberrant keratinization and autoinflammation, raising the question whether it represents an autoinflammatory keratinization disease, a recently proposed disease entity. In this mini review, I introduce the concept of autoinflammatory keratinization disease and attempt to address this clinically important question.
Collapse
Affiliation(s)
- Toshifumi Nomura
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| |
Collapse
|
17
|
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]
|
18
|
Szepietowski JC, Matusiak Ł. Hidradenitis Suppurativa: The Disease Which Stimulates Researchers and Clinicians. Dermatology 2020; 236:5-7. [PMID: 31955165 DOI: 10.1159/000505542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 12/19/2019] [Indexed: 01/07/2023] Open
Affiliation(s)
- Jacek C Szepietowski
- Department of Dermatology, Venereology, and Allergology, Wroclaw Medical University, Wroclaw, Poland,
| | - Łukasz Matusiak
- Department of Dermatology, Venereology, and Allergology, Wroclaw Medical University, Wroclaw, Poland
| |
Collapse
|
19
|
Bieber T. Neuartige Therapien auf der Grundlage der Pathophysiologie der atopischen Dermatitis. J Dtsch Dermatol Ges 2019; 17:1150-1163. [PMID: 31765109 DOI: 10.1111/ddg.13965_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 09/17/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Thomas Bieber
- Klinik und Poliklinik für Dermatologie und Allergologie, Universitätsklinikum, Rheinische Friedrich-Wilhelms-Universität Bonn, Erklärung zu nicht-finanziellen Interesse: Organisation: Klinik und Poliklinik für Dermatologie und Allergologie Position in dieser Organisation: Direktor Mitgliedschaft und Position in wissenschaftlichen Gesellschaften/Berufsverbänden/Vereinigungen: Direktor bei Christine-Kühne Center for Allergy Research and Education (CK-CARE) der Kühne-Stiftung; Sprecher beim Zentrum für Translationale Medizin (Med. Fakultät Bonn und Bundes -Institut für Arzneimittel und Medizinprodukte (BfArM), Bonn; Vorsitzender des Wissenschaftlichen Beirates des BfArM, Bonn; Stellvertretender Vorsitzender des gemeinsamen Wissenschaftlichen Beirates der Bundesoberbehörden am Bundesministerium für Gesundheit (BMG), Berlin; Mitglied der Nationalen Akademie der Naturforscher, Leopoldina Halle; Ehrenamtliches Mitglied folgender Aufsichtsräte: Hochgebirgsklinik (Davos) sowie Davos Biosciences (Davos, Schweiz). Mitglied und Ehrenmitglied zahlreicher nationaler und internationaler wissenschaftlicher Gesellschaften
| |
Collapse
|
20
|
Berman HS, Villa NM, Shi VY, Hsiao JL. Guselkumab in the treatment of concomitant hidradenitis suppurativa, psoriasis, and Crohn’s disease. J DERMATOL TREAT 2019; 32:261-263. [DOI: 10.1080/09546634.2019.1654067] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Hannah S. Berman
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Natalie M. Villa
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Vivian Y. Shi
- Division of Dermatology, Department of Medicine, University of Arizona, Tucson, AZ, USA
| | - Jennifer L. Hsiao
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| |
Collapse
|