Brodalumab for severe hidradenitis suppurativa: a case of clinico-radiologic improvement and literature review

Figures & data

Figure 1. HS manifestations of the Axillary and gluteal regions at baseline (A–C) and after 136 weeks of treatment with brodalumab (E–G). MRI of the lower abdomen and pelvis performed at baseline showed widespread morphologic and signal intensity alterations in the subcutaneous soft tissue, localized in the gluteal region bilaterally (yellow arrows). in addition, numerous abscesses mainly involved the gluteus maximus muscle (red stars) but smaller lesions also affected the intergluteal fold and the scrotal region, extending to the pararectal location (D). MRI of the lower abdomen and pelvis performed after 96 weeks demonstrated a reduction in the thickness of the subcutaneous adipose tissue that was associated with fibroadipose involution of the gluteus maximus muscle bilaterally (yellow arrows). fibrotic areas with sporadic abscesses and drainage tunnels are found in the adipose tissue of the ischioanal fossa (red stars). However, a significant reduction of the fluid component was recognized in the locoregional soft tissue compared to the previous examination (H).

Table 1. Patients’ demographics, disease characteristics and brodalumab treatment outcome in all reported patients.

Authors	No. of patients	Sex	Age (yrs)	Comorbidities	Previous biological therapies	Hurley stage	Broda dosage	HiSCR	IHS4	Modified Sartorius score	DLQI	Duration of treatment
Tampouratzi E et al, 2019	1	M	42	PsO, PsA	GOL, ADA, USTE, SECU	II	210 mg 0,1,2, Q2W	–	Baseline: 10 16 weeks: 3	–	Baseline: 25 12 weeks: 1	12 months
Frew JW et al, 2020 (NCT03960268)	10	5M 5F	36 (21-55)	Uveitis (1) Pyoderma gangrenosum (3) Arthritis (3) Smokers (6)	ADA (7), IFX (4), SECU (2), IXE (2)	II (8) III (2)	210 mg 0,1,2, Q2W	Week 12: 10/10 HiSCR-75: 70% HiSCR-100: 40% Week 24: 10/10 HiSCR-75: 100% HiSCR-100: 40%	80% achieved a IHS4 category change at week 12 40% had a 2-category change in IHS4 at weeks 12 and 24	–	–	24 weeks
Arenbergerova M et al, 2020	1	M	45	Smoker	ADA	III	210 mg 0,1,2, Q2W	–	Baseline: 62 12 weeks: 18	–	Baseline: 17 12 weeks: 5	9 months
Frew JW et al, 2021 (NCT04249713)	10	Seven of the 10 patients included in the NCT03960268 study participated to this trial. No additional demographic data of the enrolled patients are available.					210 mg 0,1,2, QW	Week 12: 10/10 HiSCR-75: 80% HiSCR-100: 50%	80% achieved a IHS4 category change at weeks 12 and 24 50% had a 2-category change in IHS4 at weeks 12 and 24	–	–	24 weeks
Yoshida Y et al, 2021	1	M	47	Smoker PsO	No	III	210 mg 0,1,2, Q2W	–	–	Baseline: 102 8 months: 30	–	18 months
Kearney N et al, 2023	8	6F 2M	38.5 (27-79)	Smokers (2)	ADA (8) IFX (5)USTE (2) GUS (1) Anakinra (1)	II (3) III (5)	210 mg 0,1,2, Q2W	1 patient experienced primary failure after 16 weeks 3 patients experienced secondary failure			Baseline: 20.6 16 weeks: 16.8	10.3 months (mean)
Our case	1	M	50	Smoker PsO	ADA, IFX, ETN	III	210 mg 0,1,2, Q2W	Week 12	Baseline: 56 48 weeks: 15 136 weeks: 5	–	Baseline: 28 48 weeks: 8 136 weeks: 4	34 months

HiSCR, Hidradenitis Suppurativa Clinical Response; IHS4, International Hidradenitis Suppurativa Severity Score; DLQI, Dermatology Life Quality Index; PsO, Psoriasis; PsA, Psoriatic Arthritis; Q2W, every 2 weeks, QW, every week.