Infliximab every 4 weeks may be beneficial in treatment of hidradenitis suppurativa

Steven R. Cohen

Infliximab maintenance therapy could reduce pain and disease activity in hidradenitis suppurativa, according to a study published in Journal of the American Academy of Dermatology.

“Physicians should be using infliximab as the standard for treating hidradenitis suppurativa,” study co-author Steven R. Cohen, MD, MPH, told Healio. “A large percentage of patients with HS have obesity as a comorbidity. When you are dealing with that, you really need a drug that is weight-based.”

The prospective analysis included 42 patients who received an induction dose of infliximab 7.5 mg/kg at weeks 0, 2 and 6, with a maintenance dose of 7.5 mg/kg every 4 weeks thereafter. In a second cohort, 16 patients who did not experience sufficient disease control after the induction dose received a dose escalation of infliximab 10 mg/kg.

An improvement of at least two grades from baseline on the Physician Global Assessment was the study’s primary outcome measure.

“Patients with severe HS benefit significantly from a starting dose of [infliximab] 7.5 mg/kg at a standard loading dose frequency (0, 2 and 6 weeks), followed by a maintenance frequency of every 4 weeks,” the study authors wrote. “This proposed therapeutic regimen may include a dose escalation to [infliximab] 10 mg/kg every 4 weeks, as needed, to achieve sufficient disease and pain control.”

Those who received the 7.5 mg/kg dose throughout the study experienced significant improvement in PGA scores, with 20 of 42 patients (47.6%) achieving a clinical response at week 4 and 17 of 24 patients (70.8%) achieving a clinical response at week 12.

For those who received the dose escalation of 10 mg/kg, six of 16 patients (37.5%) achieved a clinical response at week 4, while six of 12 patients (50%) did so at week 12.

Mean Numerical Rating Scale pain score decreased from 5.7 at week 0 to 1.3 at week 4 and 0.5 at week 12 in the 7.5 mg/kg group. For those in the dose escalation group, mean pain severity scores were 4.3 at week 0, decreasing to 1.7 and 0.8 at weeks 4 and 12, respectively.

Humira (adalimumab, AbbVie) is an FDA-approved HS treatment; however, its efficacy can be limited, especially in patients with obesity, according to Cohen.

“With Humira, if you have a patient who is 120 pounds and you give them a dose that is the same as someone who is 350 pounds, you can see where there might be a problem distributing the same dose of drug in that much body mass, whereas if you have a weight-based drug, you are going to give the patient exactly what they need for their weight,” Cohen said.

“Like other TNF drugs, infliximab doesn’t have organ toxicity. This is a really safe alternative in a patient population that is totally shut down physically and socially,” he said.

Use of infliximab as a treatment for HS is limited mostly by insurance approval; however, Cohen said that better control of the disease reduces the number of hospitalizations and improves a person’s ability to contribute to society, making the cost-benefit ratio more attractive.

“We don’t put people with early-stage disease on this regimen,” Cohen said. “These are patients who don’t have much of a life right now. We are recommending it for people with advanced disease.” – by Rebecca L. Forand

Disclosures: Cohen reports he has served as principal investigator and on the advisory board for AbbVie and on the advisory board for Verrica Pharmaceuticals. The other authors report no relevant financial disclosures.