Increased Doses of Adalimumab are Associated With Clinical Improvement of Hidradenitis Suppurativa

June 2023 | Volume 22 | Issue 6 | 615 | Copyright © June 2023


Published online May 10, 2023

doi:10.36849/JDD.6868

Jazzmin Williams BSa, Claudia Guzik BSb, Akhil Wadhera MDc, Haley Naik MD MHScd

aSchool of Medicine, University of California San Francisco, San Francisco, CA
bCollege of Medicine, Drexel University, Philadelphia, PA
cDepartment of Dermatology, Kaiser Permanente Fremont Medical Center, Fremont, CA
dDepartment of Dermatology, University of California San Francisco, San Francisco, CA

Abstract
Background: TNF-inhibitor adalimumab 40 mg/week (ADA40) is the only approved treatment for hidradenitis suppurativa (HS); however, it is not uniformly effective. Despite a high prevalence of comorbid obesity in HS patients, adalimumab dosing is not weight-based, unlike other TNF-inhibitors.
Objective: To evaluate the effectiveness of adalimumab 80 mg/week (ADA80) compared with ADA40 in overweight and obese patients with moderate to severe HS.
Methods: We conducted a dual-center retrospective chart review of HS patients treated with ADA80 between August 2016 and December 2021. We collected data on demographics, comorbidities, treatments, and disease severity that are presented as descriptive statistics and compared with Wilcoxon signed-rank test.
Results: Eight patients with median body mass index of 36.6 (IQR 32.5–40.7) and no improvements in HS severity on ADA40 were prescribed ADA80. Patients experienced improved HS-Physician Global Assessment (ADA40: median 3.0 (3.0-3.8); ADA80: (2.0 (1.8, 2.0)) (P=0.01)), all 5 patients who had lesion counts documented achieved HS Clinical Response, and all 8 patients reported symptom improvements.
Conclusions: Increased adalimumab dose may be associated with improved outcomes for overweight and obese patients with moderate to severe HS.

J Drugs Dermatol. 2023;22(6) doi:10.36849/JDD.6868

INTRODUCTION

Hidradenitis suppurativa (HS) is a debilitating chronic inflammatory disease with a single approved treatment, TNF-antagonist adalimumab 40 mg/week (ADA40). However, only half of patients treated with ADA40 achieved Hidradenitis Suppurativa Clinical Response (HiSCR) in phase 3 trials.1 We suspect that the limited effectiveness of this drug may be affected by inadequate dosing. HS patients are 4-times more likely to be obese than the general population, however, unlike other TNF-inhibitors, adalimumab dosing is not weight-based.1,2 In this study, we evaluated the effectiveness of adalimumab 80 mg/week (ADA80) in 8 overweight and obese HS patients with ADA40-refractory disease.

MATERIALS AND METHODS

In this dual-center retrospective cohort study, patients seen between August 2016 and December 2021 with an ICD-10 code for HS and treated with ADA40 were screened for dose escalation to ADA80. Patients were included if they had a Hurley or HS-Physician Global Assessment (HS-PGA) score indicating moderate or severe HS, had a BMI >25, and were treated with ADA80 for at least 3 months. Data were collected on demographics, comorbidities, treatments, adverse events, patient-reported symptoms, and HS severity (HS-PGA and HiSCR) at ADA40 and ADA80 (Table 1). We report descriptive statistics and comparisons using Wilcoxon signed-rank test. This study was approved by the University of California, San Francisco Institutional Review Board (IRB) and did not require approval from the Kaiser Permanente Northern California IRB.

RESULTS

Eight patients (6 female, 2 male) from diverse racial backgrounds (5 Black, 2 White, and one multiracial: White and Asian) were included in the study. At the time of dose escalation from ADA40 to ADA80, median age was 37.0 years (25.5-41.5), and median BMI was 36.6 (32.5-40.7). Median follow-up on ADA40 was 11.2 months (9.3-20.1), and 13.2 months (3.7-27.2) on ADA80.
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