[nastassia]

Long-term efficacy of a single course of infliximab in hidradenitis suppurativa

B. H. Thiers, MD; Courtesy of Eclips Consult ([Ссылки доступны только зарегистрированным пользователям ])

Summary

Abstract

Background:

Hidradenitis suppurativa is a chronic inflammatory skin disease characterized by abscess formation, predominantly in the axillae and groins. The disease is difficult to treat and has a severe impact on quality of life. Recently, several case reports have been published describing successful treatment of hidradenitis suppurativa with infliximab and other tumour necrosis factor α inhibitors.

Objectives:

To evaluate the long-term efficacy of a single course of infliximab.

Methods:

Ten patients with severe, recalcitrant hidradenitis were treated with infliximab (three infusions of 5mgkg−1 at weeks 0, 2 and 6) and followed up for at least 1 year. The disease activity was measured using laboratory parameters and a recently developed acne score. The patients rated the efficacy of infliximab on a 10-point scale at regular intervals. Quality of life was measured before and after treatment using the Dermatology Quality of Life Index (DQLI).

Results:

All patients improved within 2–6 weeks. The average acne score diminished from 164±50 (mean±SD) before treatment to 89±49 after 1 year (P=0·002). The mean CRP (C-reactive protein) was reduced from 31·7mgmL−1 to 5·5mgmL−1 after 1 month (P=0·015). Patients judged the efficacy with a score of 7·9. The mean DQLI was reduced from 18·4±7·9 before treatment to 9·3±9·1 after 1 year (P=0·007). In three patients long-lasting improvement was observed, with no recurrence of lesions in a 2-year follow-up period. The other patients showed recurrence of lesions after 8·5 months (range 4·3–13·4 months).

Conclusions:

Infliximab is an effective treatment in severe hidradenitis suppurativa, leading to reduction of symptoms for a prolonged period.

Commentary by B.H. Thiers, MD

Posted Date: 11 Jun 2009

Evidence Ranking: B

Hidradenitis suppurativa is a debilitating chronic inflammatory condition of apocrine glands that is highly refractory to treatment. Although some physicians believe it may be related to acne (hence its alternate designation, acne ectopica or acne inversa), the condition responds poorly to treatments used for acne, and even isotretinoin is often ineffective, despite the use of doses higher than one would typically use for treating acne vulgaris. Nonspecific antiinflammatory therapy, including systemic corticosteroids, is useful for short-term control, although long-term administration in a chronic disease such as this is fraught with unacceptable complications. The hypothesis that the proinflammatory cytokine, TNF-α, may be involved in the pathogenesis of hidradenitis has led to numerous case reports of the use of TNF-α inhibitors as a possible treatment. These reports have yielded mixed results. In the study by Mekkes and Bos, a single course of 3 infusions of the TNF-α inhibitor, infliximab, led to short-term improvement in all 10 patients, although 7 relapsed an average of 8.5 months after therapy. A previous study by Fardet et al included 7 patients with hidradenitis who were treated with 3-4 infusions of infliximab.[1] Again, most improved in the short-term, but most relapsed later. In both of these studies, adverse drug reactions were seen in a significant minority of patients. Taken together, the data appear to suggest that TNF-α inhibitors, specifically infliximab, may have some short-term benefit for treating hidradenitis, but maintenance infusions will be necessary to maintain improvement.

References

1. Mekkes JR, Bos JD, et al: Long-term efficacy of a single course of infliximab in hidradenitis suppurativa. Br J Dermatol 2008; 158:370-374.