Biologic therapies for the treatment of hidradenitis suppurativa

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.

KEYWORDS:

• Hidradenitis suppurativa
• biological therapies
• HS therapy

Article highlights

• Adalimumab is currently the only FDA-approved biologic therapy for hidradenitis suppurativa

• Biologic treatment options for patients with HS is currently limited, which includes adalimumab and infliximab

• There are currently multiple studies on biological therapies that may become FDA-approved in the future

• Most of the biological therapies currently being studied were selected based on currently approved psoriasis biologic therapies

• While there is limited safety data on biological therapies being studied in HS, information from previous studies is used for safety monitoring

• There are limited studies on biosimilar use for HS; however, there is currently a phase I study for an adalimumab biosimilar.

Acknowledgments

The authors would like to thank Dr. Kelsey Flood for allowing us to use the adapted and updated table from her article, “Biologic treatment for hidradenitis suppurativa” from the American Journal of Clinical Dermatology.

Declaration of Interest

AB Kimball serves as a consultant and investigator for Novartis, Abbvie, UCB, Pfizer, Lilly, and Janssen. Her fellowship program receives funding from Janssen and Abbvie. M Porter serves as a consultant to AbbVie, Pfizer, and Novartis. M Rosales Santillan has received fellowship funding from AbbVie and Janssen that went directly to her institution. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.