Background Hidradenitis suppurativa (HS) is a chronic suppurative condition featuring inflammatory nodules, fistulas and scars. Its prevalence is estimated at 1% in Wwestern Europe. Adalimumab (Humira®) was approved in June 2015 as the first TNF blocker indicated for adults with active moderate to severe HS refractory to conventional treatment.
Purpose To evaluate the use of adalimumab in HS in a tertiary hospital.
Material and methods A retrospective, descriptive, observational study was conducted. We included all patients undergoing adalimumab therapy since off-label prescription began in our hospital (January 2012) until August 2017.
We assessed demographic characteristics, date of initiation of adalimumab, initial doses, previous and concomitant therapies, adverse events and clinical evolution. The information was collected from the medical records.
Results Twenty-four patients were recruited; 13 (54%) were females. The median (IQR) age was 32 (25–45.5) years. Twenty (83.3%) patients were diagnosed with moderate (25%) or severe (75%) HS and four patients were unclassifiable. Everyone had previously received conventional treatment: topical clindamycin (79.2%), systemic antibiotics (70.8%) and oral retinoids (62.5%).
We found that five (20.8%) patients had started off-label therapy, while 19 (79.2%) had initiated adalimumab after the approval date. Only 10 of them (41.7%) had received adalimumab according to the technical specifications of the Food and Drug Administration (FDA). Among the rest of the patients, nine (37.5%) had not received any loading dose and five (20.8%) had taken a lower one.
In terms of effectiveness, eight (33.3%) patients had interrupted the therapy: 2/8 due to adverse events, 5/8 due to lack/loss of response – none of them had followed the approved treatment scheme – and 1/8 due to exacerbations of co-morbidities. Finally, 50% of patients had received concomitant therapy at some point, mainly, intralesional triamcinolone (37.5%).
Conclusion The therapeutic approach in HS is highly variable, maybe because of the multifaceted clinical features of HS and its unpredictable course. The considerably long experience that clinicians have with adalimumab in other pathologies may explain the wrong dosages observed. Furthermore, adalimumab seems to be safe and well tolerated. athough the loss of response is quite alarming.
No conflict of interest
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