Hidradenitis Suppurativa Responsive to TNF Inhibitor Therapy
WASHINGTON, DC—Tumor necrosis factor (TNF) inhibitors yield promising responses among patients with chronic, recurring-abscessing sweat-gland inflammation known as hidradenitis suppurativa (HS), according to research findings presented at the 2016 ACR/ARHP Annual Meeting.
“Treatment with TNF-α inhibitors was associated with significant improvement in disease activity scores in this population,” reported lead study author Shaunak Mulani, MD, of George Washington University in Washington, DC.
HS occurs in between 1% and 4% of young adults but little is known about its molecular mechanisms or treatment options, Dr. Mulani noted.
Disease modifying anti-rheumatic (DMARD) therapies are “largely ineffective” against HS, Dr. Mulani said. But adjuvant therapy with targeted biologic therapies such as TNF-α inhibitors have shown promise.
The study team therefore studied biologic agent therapies' associations with HS Scores (HSS) and Hurley Stage in a specialized U.S. clinic, through the Wound Etiology and Healing (WE-HEAL) study data and biospecimen repository.
A total 67 out of 565 WE-HEAL study patients had HS (mean age 40.4 years). HS disease activity was assessed using Active Nodule count (AN count), Hurley Stage and Hidradenitis Sartorious Score (HSS). Medication exposure associations with HSS and Hurley Stage were analyzed. Patients with a higher baseline HSS score were more likely to have been exposed to biologics (P=0.021).
"After adjusting for the effects of time-varying surgery, time-varying BMI, time-varying opioid dose, time-varying pain score, baseline Hurley Stage, smoking, and hypertension, patients with biologics present had a mean HSS 12.0 points lower than patients without biologics (P=0.009), noted Dr. Mulani.
Significant predictors of improvement in the AN count included: HS surgery (P=0.0016), disease activity at baseline, being prescribed biologics (P=0.001), time, and the surgery x time interaction (P=0.0031).
The findings also indicated that biologic use was tied to a 0.6 AN unit drop vs. no biologic use (P=0.0029).
Dr. Mulani concluded, "In this study, we were able to show that treatment with biologic agents significantly decreases disease activity scores. This finding is consistent with other clinical studies demonstrating response of moderate to severe HS to TNF-alpha inhibition." Overall, the use of biologics, in combination with surgery, showed significant improvement in disease activity scores for this cohort.