Longitudinal observational study of hidradenitis suppurativa: impact of surgical intervention with adjunctive biologic therapy |
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| Authors: | Victoria K. Shanmugam MD MRCP Shaunak Mulani BA Sean McNish MS CRA Sarah Harris NP Teresa Buescher MD Richard Amdur PhD |
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| Affiliation: | 1. Division of Rheumatology, Ideas to Health Laboratory, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA;2. Department of Plastic Surgery, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA;3. Department of Surgery, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA |
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| Abstract: | Background Hidradenitis supppurativa (HS) is a chronic inflammatory disease of the apocrine sweat glands affecting 1–4% of the population. While surgical excision is a mainstay of therapy, lesions often recur. Biologic therapies, including tumor necrosis factor‐α and IL‐12/23 inhibitors, are effective for mild to moderate HS. However, longitudinal studies investigating biologic therapy in conjunction with surgery are limited. The purpose of this analysis was to investigate impact of surgery and biologic therapy on HS disease activity. Methods Data from 68 HS patients were analyzed. Outcome measures included hidradenitis suppurativa Sartorius Score (HSS), active nodule (AN) count, Hurley stage, and probability of achieving 75% reduction in active nodule count (AN75). Results Mean age was 40 ± 14 years; 66% were female and 72% were African American. Mean disease duration was 10 years, and Hurley stage III disease was seen in 63% of patients. Patients who received biologics had a larger drop in HSS and AN count than those who never received biologics (P = 0.002). Biologic treatment was associated with average reduction in 22 (15–29) HSS points (P < 0.0001). The effect of biologics was greater in patients who also underwent surgery (P = 0.013). Timing of biologics relative to surgery did not impact efficacy. Patients who received HS surgery with biologic therapy were most likely to achieve the AN75 (P = 0.017). Conclusions In this diverse cohort of patients with severe HS, biologic therapy was associated with a more rapid decline in disease activity, with the greatest effect in patients who also underwent HS surgery. |
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| Keywords: | hidradenitis suppurativa tumor necrosis factor‐α inhibitor IL12/23 inhibitor ustekinumab adalimumab infliximab surgery |
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