Etanercept shows low drug survival in hidradenitis suppurativa

Etanercept was associated with reduced drug survival rates compared with other biologic therapies used to treat hidradenitis suppurativa, according to a study.

“Biologics are important in treating patients with HS,” Hans Christian Ring, MD, PhD, of the department of dermato-venereology and wound healing centre at Bispebjerg Hospital in Copenhagen, Denmark, and colleagues wrote. “However, to our knowledge, data on their real-life performance and treatment patterns in HS are limited.”

The aim of the current cohort study was to assess drug survival of biologic drugs used to treat HS. The 241 eligible participants were accrued at five academic hospitals in Denmark between Jan. 1, 2005, and Dec. 31, 2018.

The drugs that underwent analysis included adalimumab, anakinra, certolizumab pegol, etanercept, golimumab, infliximab, secukinumab and ustekinumab.

The cohort was 61.8% women with a mean age of 41.8 years (standard deviation, 12.6 years) at initiation of first biologic.

The overall number of treatment series included was 386. Among 256 adalimumab series, 73.8% were biologic naïve. Of the 66 infliximab series, 48.5% were naïve, while 39.1% of the 23 etanercept series and 40.9% of the 22 ustekinumab series were naïve.

The median time to discontinuation was 36 weeks (interquartile range [IQR], 21.9-63) for adalimumab, 28.7 weeks (IQR, 15.1-62.9) for infliximab, 26 weeks (IQR, 16.9-155.9) for ustekinumab and 17.9 weeks (IQR, 12.9-41) for etanercept.

Etanercept was associated with significantly higher drug discontinuation rates than a number of other therapies, including adalimumab (adjusted HR = 1.81; 95% CI, 1.16-2.82), infliximab (aHR = 1.77; 95% CI, 1.03-3.05) and ustekinumab (aHR = 2.49; 95% CI, 1.12-5.52).

When adalimumab, infliximab and ustekinumab were compared for drug discontinuation rates, no significant differences were observed.

In addition, drug survival was not significantly different among biologic-naïve versus non-naïve patients, according to the findings.

Factors that were associated with infliximab discontinuation included increasing C-reactive protein levels (aHR = 1.01; 95% CI, 1-1.03) and concomitant antibiotic treatment (aHR = 2.82; 95% CI, 1.36-5.86).

Men were less likely than women to discontinue adalimumab (aHR = 0.69; 95% CI, 0.51-0.91).

“In this cohort study, drug survival was comparable between adalimumab, infliximab and ustekinumab but significantly lower for etanercept,” the researchers concluded. “Drug survival in patients with HS appears to be considerably lower than seen for other inflammatory diseases, such as psoriasis, thus suggesting the complex role of proinflammatory cytokines in the pathogenesis of HS.”