Patients with hidradenitis suppurativa benefit when treatment combines adalimumab, surgery

Key takeaways:

• Patients achieved a reduction of 19.1 in HS severity when treated with combined surgery vs. a reduction of 7.8 with monotherapy.
• The mean reduction was 8.2 in Dermatology Life Quality Index in the surgery group.

Adalimumab accompanied by surgery significantly out-performed adalimumab monotherapy in the treatment of patients with moderate to severe hidradenitis suppurativa, according to a study.

“While the treatment of [hidradenitis suppurativa (HS)] has improved over recent years with the registration of adalimumab for HS, this treatment still only shows a response in up to 60% of patients,” Pim Aarts, MD, of the department of dermatology at the Erasmus University Medical Center in Rotterdam, the Netherlands, and colleagues wrote.

“Surgery (deroofing, limited or wide excision) is frequently used as additional therapy in clinical practice,” the researchers continued. “However, the added value of surgical intervention during adalimumab treatment has not yet been investigated in a controlled study.”

In this randomized controlled phase 4 trial, researchers compared the real-world effectiveness of adalimumab accompanied by adjuvant surgery with adalimumab monotherapy in patients with moderate to severe HS.

Conducted from August 2018 to July 2022, each treatment group included 31 patients who received 40 mg of adalimumab once weekly for 12 months. Those in the surgery group additionally received a maximum of two surgical interventions, such as deroofing, limited excision or wide excision.

Results showed that a greater portion of the surgery group achieved a mean reduction in International Hidradenitis Suppurativa Severity Score System compared with the monotherapy group (–19.1 ± 11.3 vs. –7.8 ± 11.8; P < .001).

The surgery group also had a higher reduction than the monotherapy group in Dermatology Life Quality Index scores (–8.2 ± 6.2 vs. –4 ± 7.7; P = 0.02). Additionally, 18 surgery-treated patients achieved a 2-point or greater change in HS Physician Global Assessment vs. four monotherapy-treated patients (58% vs. 13%; P < .001). However, abscess and inflammatory nodule count as well as HS clinical response were comparable between groups.

Twenty-nine monotherapy-treated patients and 21 surgery-treated patients experienced 79 and 49 adverse events, respectively. The authors reported that 73% of adverse events were possibly related to treatment across both groups, with the most common being HS flares, viral and bacterial infections, injection site hematoma, surgical site mild bleeding, and post-operative pain.

“The combination of adalimumab with surgery showed significantly greater clinical effectiveness and improvement in quality of life than adalimumab monotherapy with a higher rate of patient satisfaction,” the authors concluded. “The therapeutic option of adalimumab with surgery should always be proposed to patients with moderate to severe HS.”