Patients with Hidradenitis Suppurativa Often Report Treatment Dissatisfaction

Amit Garg, MD

New findings suggest a high proportion of patients with hidradenitis suppurativa (HS) reported dissatisfaction with treatment.

Factors that appeared to influence positive treatment satisfaction in this population included primary treatment by a dermatologist and treatment with a biologic. Meanwhile, the likelihood of satisfaction was lower among smokers, those with comorbidities including depression, and those with increasing flare frequency.

“Improving awareness and access may be critical to improving outcomes for HS patients, as it  has been previously shown that care by a dermatologist offers higher likelihood of treatment initiation and treatment escalation,” wrote study author Amit Garg, MD, Department of Dermatology, Donald & Barbara Zucker School of Medicine at Hofstra Northwell.

The analysis of the Global Survey Of Impact and Healthcare Needs (Global VOICE) project aimed to evaluate unmet needs in the disease space from the perspective of the patients in order to support awareness, multidisciplinary approaches to care, and advancements in treatment. Data from the study suggest half of patients with HS were dissatisfied with their medical treatments.

At the time being, only one regulatory approved treatment for moderate to severe HS is available, in which half of patients are expected to have a nearly 50% improvement from baseline count of inflammatory nodules and abscesses. Outcomes may be optimized based on understanding patient factors influencing satisfaction with treatment.

Investigators assessed treatment satisfaction with data from a cross-sectional global survey of patients with HS recruited from 27 institutions in 14 different countries from October 2017 to July 2018. The primary outcome was the patients’ self-reported overall satisfaction with their current treatments for HS, on a 5-point scale from “very dissatisfied” to “very satisfied”.

The cohort for the final analysis consisted of 1,418 patients with HS. Data show most were European (55%; n = 780) or North American (38%; n = 542), and female (85%; n = 1210). Additionally, the majority of patients were either treated with a non-biologic systemic medication (n = 519; 42%) or received no medical treatment at all (32%; n = 451).

Overall, the investigators found 45% (n = 640) of participants were either dissatisfied or very dissatisfied with their current medical treatment. This patient population reported common reasons for dissatisfaction including poor efficacy (76%; n = 489), undesirable side effects (33%; n = 210), expense (19%; n = 120), inconvenience (19%; n = 119), and invasiveness (14%; n = 90).

Compared to patients reporting flares every 6 months, the odds of treatment satisfaction were observed to be lower for patients with flare frequency every 3 months (odds ratio [OR], 0.83; 95% confidence interval [CI], 0.51 - 1.35], monthly (OR, 0.43; 95% CI, 0.28 - 0.66), weekly (OR, 0.23; 95% CI, 0.15 - 0.35), and daily (OR, 0.18; 95% CI, 0.11 - 0.28).

In adjusted analysis, those primarily treated by a dermatologist had 1.99 (95% CI, 1.62 - 2.44; P <.001) times the odds of being satisfied with current treatment than those not primarily treated by a dermatologist.

Moreover, biologic treatment was associated with higher satisfaction (OR, 2.36; 95% CI, 1.74 - 3.19; P <.001) in comparison to non-biologic systemic medication treatment. The factors associated with lower satisfaction including smoking (OR, 0.78; 95% CI, 0.62-0.99), depression (OR, 95% CI, 0.54 - 0.87), and an increasing number of comorbidities (OR, 0.88 per comorbidity; 95% CI, 0.81 - 0.96).

“Awareness of these factors by physicians and patients may support partnered decision making  which may improve outcomes,” Garg added.

The study, “Factors associated with treatment satisfaction in patients with hidradenitis  suppurativa: results from the Global VOICE project,” was published in the British Journal of Dermatology.