JAK inhibitors may be ‘useful tool’ in hidradenitis suppurativa

Strong clinical responses were observed in a small cohort of patients with hidradenitis suppurativa treated with the Janus kinase inhibitor upadacitinib, according to study findings.

“JAK inhibitors target multiple cytokines rather than just one with monoclonal antibodies and hence are more appropriate for the complex inflammation seen in HS,” John W. Frew, PhD, MBBS, MMed, MSc, of the Laboratory of Translational Cutaneous Medicine at the Ingham Institute of Applied Medical Research in Sydney, Australia, a staff specialist dermatologist at Liverpool Hospital in Sydney, Australia, and a conjoint senior lecturer at the University of New South Wales in Kensington, Australia, told Healio.

Frew and colleagues conducted a retrospective cohort study that included 20 patients with moderate to severe HS treated with upadacitinib (AbbVie) between October 2021 and May 2022.

Screening at baseline, week 4 and week 24 included complete blood count, biochemistry, lipid and creatine kinase levels.

Upadacitinib was assigned to all patients at a dose of 15 mg per day until week 4. Patients who failed to reach Hidradenitis Suppurativa Clinical Response (HiSCR) at week 4 were switched to a 30 mg dose.

Results showed that 75% of the cohort achieved HiSCR 50 by week 4. By week 12, that proportion of responders had reached 100%. This response was maintained through 24 weeks.

Regarding HiSCR 75 rates, 30% of patients reached this endpoint by week 4 and 95% had reached it by week 12, with this response maintained through week 24.

HiSCR 90 rates were 20% at week 4 and 30% at weeks 12 through 24.

Turning to the endpoint of International Hidradenitis Suppurativa Severity Score, results showed that 15% of patients underwent deroofing procedures after week 24 of therapy with no adverse outcomes in the postoperative setting.

Frew offered a comment regarding patients who received the 30 mg dose of upadacitinib. “The findings suggest that the higher dose is associated with clinical response even in severe recalcitrant cases of HS,” he said.

The researchers concluded that the single-center study of upadacitinib monotherapy in this patient population was “positive” and may bode well for JAK inhibition overall.

“JAK inhibitors can be a useful tool in the treatment armamentarium against HS — particularly for severe disease,” Frew said.