Patients with overweight, obesity benefit from increased dose of adalimumab

Key takeaways:

• Five patients achieved Hidradenitis Suppurativa Clinical Response with 80 mg weekly adalimumab, whereas two patients achieved the same with 40 mg weekly adalimumab.
• There were no adverse events.

Increased adalimumab dosage may improve disease severity in patients with overweight or obesity with moderate to severe hidradenitis suppurativa, according to a study.

Adalimumab, a TNF-antagonist, is the only FDA-approved medication for the treatment of HS. Treatment is 40 mg every week (ADA40). However, according to the authors, only half of patients treated with ADA40 achieve significant responses in phase 3 trials.

“We suspect that the limited effectiveness of this drug may be affected by inadequate dosing,” Jazzmin C. Williams, BS, of the University of California, San Francisco, School of Medicine, and colleagues wrote. “HS patients are four-times more likely to be obese than the general population; however, unlike other TNF-inhibitors, adalimumab dosing is not weight-based.”

This retrospective cohort study included eight patients with a median BMI of 36.6 kg/m² and moderate to severe HS. Following ADA40 treatment, patients were escalated to adalimumab 80 mg every week (ADA80) for at least 3 months.

Results showed no disease improvement in HS physician global assessment (HS-PGA) scores among the six patients treated with ADA40 (median, 3; interquartile range [IQR], 3-3.8) compared with pre-ADA40 data (median, 3; IQR, 3-3). All patients exhibited new and recurrent inflammatory lesions at the time of transition to ADA80.

After transition, ADA80 treatment caused a 1-point reduction in HS-PGA (median, 2; IQR, 1.8-2). Hidradenitis Suppurativa Clinical Response was achieved in all five patients taking ADA80 that had lesion data available compared with two patients that achieved the same during ADA40 treatment.

No adverse events associated with ADA80 were reported.

“Appropriately dosed disease-modifying treatments prescribed early in disease course may have a role in preventing disease progression to irreversible scarring and disfigurement,” the authors wrote. “Our findings support use of increased doses of adalimumab to achieve better disease control for overweight and obese HS patients.”