Drug Survival of Hidradenitis Suppurativa Patients Treated with Infliximab, Adalimumab

Albert Young MD, MAS

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Infliximab shows superior drug survival to adalimumab in treatment of patients with hidradenitis suppurativa (HS), according to recent findings, and adverse prognostic factors for failure of treatment with adalimumab are obesity, younger age, groin involvement, and Hurley Stage III disease.

These findings and more were presented at the 2024 American Academy of Dermatology (AAD) Annual Meeting in San Diego, California. The research was led by Albert Young MD, MAS, of the Henry Ford Health System.

The study was conducted to look at the TNF-α inhibitors adalimumab and infliximab, observing factors linked to treatment failure with both drugs among HS patients. Young and colleagues noted that many individuals have been known to fail in their response to such therapies, though the reasons why are as of yet somewhat unclear.

Infliximab and adalimumab are both biologic medications which are frequently implemented in the treatment of patients with HS. The drugs, nevertheless, often have challenges related to their variability in determinants of patients’ responses to such treatment.

To address these knowledge gaps, Young and colleagues’ research assessed individuals from a specialized HS referral clinic. These individuals with HS had, for at least 90 days, been treated with adalimumab or infliximab for their condition.

In the end, the study ended up being composed of 135 participants total, and these individuals were shown to have a median age of 40 and a range from 19 - 67 years. The investigators also noted that 72% of these subjects were reported as female and 45% were categorized as of Black ethnicity.

The research team implemented multivariate Cox proportional-hazards models, assessing survival of the drug and drawing connections to a variety of elements such as gender, age, family medical history, body mass index (BMI), ethnicity, age at the time of HS onset, Hurley stage, habits related to smoking cigarettes, anatomical regions that have been impacted, and prior biologic therapy use.

Among the 135 participants in the study, 117 individuals had been given adalimumab for a median duration of about 304 days (IQR: 153, 458). The investigators found that 66% of these subjects, within the initial year, discontinued their use of adalimumab and it was due to reported ineffectiveness.

In the other arm of the study, the research team noted that 84 of the 135 participants had been given infliximab over a median of 464 days (IQR 299, 878). The team reported that there was a rate of drug discontinuation of 22%, resulting from reported ineffectiveness within the initial year.

Failure of adalimumab, on the one hand, was shown by the research team to have been connected to such factors as BMI of 30-40 (HR 2.26 [95% CI 1.18-4.27]), BMI over 40 (HR 2.46 [95% CI 1.22-4.96]), and younger age (HR 1.03 [95% CI 1.002-1.06] per year). Additional factors the team reported included Hurley stage III disease as opposed to stage II (HR 3.91 [95% CI 1.83-8.35]), and involvement of participants’ groin areas (HR 3.87 [95% CI 1.47-10.18]).

The investigators could find no variables which proved to have a statistically-significant correlation with failure of infliximab treatment. This lack of predictive factors was notable, given that the study had been the largest reported cohort to date, though the team noted the limitations of a retrospective single-center study.

Overall, the research team had pointed to the apparent superiority of infliximab in terms of drug survival compared to rates of survival with adalimumab. The team still identified several different adverse prognostic factors for adalimumab failure, providing greater understanding of HS disease and response to the drug.

The investigators’ lack of statistically significant infliximab response predictors indicated the necessity of more nuanced information. They highlighted the potential for data on biomarkers or genetic information, adding that larger sample sizes could also contribute to their research.

References

1. ^{Ghias MH, Hyde MJ, et al. Role of the Complement Pathway in Inflammatory Skin Diseases: A Focus on Hidradenitis Suppurativa. J Invest Dermatol. 2020 Mar;140(3):531-536.e1. doi: 10.1016/j.jid.2019.09.009. Epub 2019 Dec 20. PMID: 31870626.}
2. ^{Prens LM, Bouwman K, Aarts P, et al. Adalimumab and infliximab survival in patients with hidradenitis suppurativa: a daily practice cohort study. Br J Dermatol. 2021 Jul;185(1):177-184. doi: 10.1111/bjd.19863. Epub 2021 May 4. PMID: 33544917; PMCID: PMC8360014.}