Systemic Therapies Often Precede Biologic Therapy in Hidradenitis Suppurativa

Hans Christian Ring, PhD

A new investigation into biologic therapy in patients with hidradenitis suppurativa found that delays in treatment could present a missed opportunity in the prevention of disease progression.

Due to the challenging nature of HS, many patients affected by the disease have long preceding treatment histories leading up to biologic therapy.

Guidelines have suggested that patients with moderate to severe HS should be treated with systemic antibiotics such as clindamycin and rifampicicn for at least 3 months, and that biologic therapy should be considered an an alternative treatment should all conventional therapies fail.

Despite this, data on real-world systemic therapies for HS prior to biologic use are lacking.

As such, investigators led by Hans Christian Ring, PhD, Department of Dermato-Venereology & Wound Healing Center in Bispebjerg Hospital in Denmark, examined patterns and quantity of systemic treatment regimens in patients with HS prior to biologic therapy in the Danish national healthcare system.

Methods

The study included all patients who received biologic therapy for HS between January 1, 2005 and December 31, 2018. The index date was the date of the first-ever biologic prescription.

Systemic treatments such as tetracycline-class drugs, rifampicin and clindamycin, acitretin, isotretinoin, dapsone, phenoxymethylpenicillin, and dicloxacillin were identified, and the team generated treatment series that were considered valid for 90 days following a filled prescription.

Notably, 2 treatment sequences were merged if the same drug was used in 2 consecutive series, with the discontinuation being less than 30 days with the exception of penicillin and/or dicloxacillin.

Treatment journeys for each patients were displayed via Sankey diagrams, and generated box-lots were utilized to show temporal distributions.

Findings

A total of 225 patients with HS were included in the study, 63.1% of whom were women. The mean age of biologic treatment introduction was 41.2 years.

Prior to biologic therapy, patients were frequently treated with penicillin (95.1%), dixloxacillin (86.2%), tetracycline (64.4%), and rifampicin/clindamycin (49.3%).

Meanwhile, 96 patients (42.7%) were treated with isotretinoin, and doxyxycline (28.9%), dapsone (12.4%), and acitretin (7.6%) were used less frequently.

Forty-eight(21.3%) patients received 5 different treatments prior to biologic therapy, while 24( 10.7%) patients received more than different treatments, with the mean number of different treatments prior to biologic therapy being 4.

Finally, the mean time from a patient’s first systemic therapy until biologic therapy was initiated was approximately 15 years and roughly 8 years when excluding penicillin and dicloxacillin.

Investigators suggested that the large number of systemic therapies used when treating HS in these patients indicated referral delays or difficulties in obtaining disease control in those with moderate to severe HS.

“Our findings emphasize the need for optimized implementation of evidence-based guidelines to harmonize treatment strategies, as well as the need to develop and license additional effective therapies for the treatment of HS,” the team wrote.

The study, "The road to biologics in patients with hidradenitis suppurativa – a nationwide drug utilization study," was published online in the British Journal of Dermatology.