Background and Importance Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease which causes painful inflamed lesions in the apocrine gland-bearing areas of the body, with high impact on patients’ quality of life. Treatment is based on a combination of surgical and medical therapies, within biological agents play a key role. Adalimumab is currently the only biologic approved, what leads to use off-label biological treatments when adalimumab fails.

Aim and Objectives Our objective is to analyse the prescription of biological treatments, dosages used and adherence in a tertiary hospital to treat HS.

Material and Methods Medical charts of patients treated with biological drugs for HS where reviewed. Demographic features (sex, age, weight, height, smoking status), clinical stage (hurley score) and biological treatment used –including dosages, number of previous lines and adherence– were recorded.

Results Forty-one patients were included. Median age was 43 (IQR 30-52) and median body mass index was 27 (IQR 24-33). Nineteen out of 41 had a hurley score of 3 (H3) and 22 had a hurley score of 2 (H2). Twenty-seven patients were on adalimumab, including all patients H2 and 5 patients H3. Sixteen out of 27 were on 40 mg q.wk, and 11 were on 80 mg q.wk. The rest of H3 patients were on: infliximab 10 mg/kg (4), infliximab 7.5 mg/kg q.4.wk (1), subcutaneous infliximab 240 mg q.wk (2), brodalumab 210 mg q.wk (3), tocilizumab 8 mg/kg q.4.wk (1), guselkumab 100 mg q.4.wk (2), and ustekinumab 90 mg q.8.wk (1). Median previous lines in H3 patients were 1 (IQR 1-3), and five of H3 patients does not show a satisfactory improvement with current treatment. Only 3 patients showed an adherence <80% to treatment based on recorded dispensations.

Conclusion and Relevance Most patients with moderate to severe HS do not respond at approved dose of adalimumab, forcing to use higher doses or switching to other biological treatments, which are also used at higher doses than indicated in the Summaty Product Characteristics. Unfortunately, these treatments are not always effective, and there is no consensus about how to manage it. It is necessary to keep a close follow up of these patients, looking for adverse events and lack of adherence.

Conflict of Interest No conflict of interest