INTRODUCTION
Hidradenitis suppurativa (HS) is a chronic, painful skin disease that is hypothesized to occur due to overexpression of pro-inflammatory cytokines such as tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6).1 It is characterized by painful nodules, sinus tracts, and abscesses which occur on the apocrine-bearing areas of the skin.2 Risk factors for HS include family history, obesity, and smoking.3 HS is also associated with significant comorbidities including metabolic syndrome, diabetes mellitus, and polycystic ovary syndrome.4 Patients with moderate to severe HS often require biological therapies for adequate disease control.5 Currently, Adalimumab is the only biological therapy approved for the treatment of HS by the Food and Drug Administration, however, there are several other off-label biologics which are used with good effect.6
There is established evidence that biologics increase the risk of infectious complications.7 However, it is unclear whether patients treated with biologics may be at an increased risk of acquiring infections.7 Considering that the most commonly reported infections in patients using biologics are respiratory tract infections, this subject became of special concern with the emergence of the Coronavirus disease 2019 (COVID-19) pandemic.8
With the advent of effective vaccines, the pandemic appears to be at its tail end. However, the consensus among immunologists, virologists, and infectious-disease scientists suggests that COVID-19 is not likely to be eradicated but will enter its endemic phase.9,10 As such, this viral infection will continue to be clinically relevant, especially in patients who use biological therapies. In these patients, COVID-19 infection may be more likely associated with complications. The presence of comorbidities associated with HS may further increase this risk.11 As such, we wanted to assess whether biologics increase the risk of acquiring respiratory infections in patients with HS.
There is established evidence that biologics increase the risk of infectious complications.7 However, it is unclear whether patients treated with biologics may be at an increased risk of acquiring infections.7 Considering that the most commonly reported infections in patients using biologics are respiratory tract infections, this subject became of special concern with the emergence of the Coronavirus disease 2019 (COVID-19) pandemic.8
With the advent of effective vaccines, the pandemic appears to be at its tail end. However, the consensus among immunologists, virologists, and infectious-disease scientists suggests that COVID-19 is not likely to be eradicated but will enter its endemic phase.9,10 As such, this viral infection will continue to be clinically relevant, especially in patients who use biological therapies. In these patients, COVID-19 infection may be more likely associated with complications. The presence of comorbidities associated with HS may further increase this risk.11 As such, we wanted to assess whether biologics increase the risk of acquiring respiratory infections in patients with HS.
