Adalimumab versus Rifampicin Plus Clindamycin for the Treatment of Moderate to Severe Hidradenitis Suppurativa: A Retrospective Study

May 2019 | Volume 18 | Issue 5 | Original Article | 437 | Copyright © 2019

Claudio Marasca MD,a Maria Carmela Annunziata MD,a Alessia Villani MD,b Salvatore Volpe MD,a Dario Marasca MD,b Gabriella Fabbrocini MDa

aDepartment of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Napoli, Italy bDepartment of General and Specialistic Surgery, A.O.U. Cardarelli, Napoli, Italy

Abstract

In the present single-center retrospective study, we investigated our data to evaluate the efficacy of the classic antibiotic combination (rifampicin and clindamycin) compared to adalimumab treatment in patients affected by moderate-to-severe hidradenitis suppurativa. Disease severity and quality of life were registered using the modified Sartorious score and Hidradisk, respectively. Data were collected before starting treatment (T0) and after ten weeks of therapy (T10). The Mann-Whitney test was used to calculate statistical differences between baseline and week 10. P values less than 0.05 were considered to be statistically significant. A spearman test was used to evaluate the correlation among the parameters under study. Thirty patients (20 females, 10 males; mean age, 23.73 ± 4.57) were given the antibiotics: instead of starting the treatment by combining the two antibiotics, we recommend patients to start the therapy taking only rifampicin 300 mg twice a day for 7 days, and after the first week, to add clindamycin at a dose of 300 mg twice a day. The mean modified Sartorius Score before starting treatment was 68.8 while the value at week 10 was 57.8 (P equals 0.0052). The mean Hidradisk value before starting treatment was 74,73 while the value at week 10 was 62 (P equals 0.0095). Ten patients (10/30) achieved the HiSCR. On the other hand, thirty subjects (22 females, 8 males; mean age, 26.2±7.25) were treated with subcutaneous injections of adalimumab (160 mg at baseline, 80 mg at week 2, 40 mg at week 4, and 40 mg weekly thereafter). The mean modified Sartorius Score before starting treatment was 74.93 while the value at week 10 was 39.86 (P less than 0.0001). The mean Hidradisk value before starting treatment was 77.73 while the value at week 10 decreased to 51.86 (P less than 0.0001). Eighteen patients (18/30) achieved the HiSCR.

J Drugs Dermatol. 2019;18(5):437-438.

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Hidradenitis suppurativa (HS) is a relapsing, inflammatory skin disease characterized by painful nodules, abscesses, fistulae, and scarring. HS has a great impact on patients’quality of life and its treatment may be really challenging.1 Mild disease can be usually managed with topical agents; nevertheless, progression to moderate or severe disease requires the use of systemic therapies, such as oral antibiotics, retinoids, and immunosuppressant drugs.2 In the present study we investigated our data to evaluate the efficacy of the classic antibiotics combination (rifampicin and clindamycin) compared to adalimumab treatment in patients affected by moderate-to-severe HS. A single-center retrospective study was performed among patients with moderate-to-severe HS attending the out-patient clinic of the Department of Clinical Medicine and Surgery, Section of Dermatology of the University of Naples Federico II from November 2017 to March 2018. Eligibility criteria were: i) clinically evident moderate to severe HS in patients aged ≥18 years and ii) with at least a 6-months diagnosis of HS. Moreover, patients with other skin diseases and in treatment with others concomitant medical treatments for HS were excluded. Written informed consent from all patients was provided. All subjects received a complete dermatologic examination: disease severity and quality of life were registered using the modified Sartorious score and Hidradisk, respectively. Hidradisk is a new visual tool for the assessment of the biopsychosocial burden posed by HS on patients.3 Data were collected before starting treatment (T0) and after 10 weeks of therapy (T10). The Mann-Whitney test was used to calculate statistical differences between baseline and week 10. P values 4 Thanks to this expedience based on clinical experience, the incidence of side-effects has significantly decreased.

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