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Vol 10, No 3 (2024)
Review paper
Published online: 2024-07-26

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Assessment of the efficacy of biological treatment in acne inversa

Aleksandra Anioła1, Sandra Ważniewicz1, Aleksandra Jonkisz1, Magdalena Płotast1, Magdalena Jałowska1
DOI: 10.5603/fd.101083
Forum Dermatologicum 2024;10(3):79-88.

Abstract

Acne inversa is a chronic, progressive inflammatory skin disease. It is characterized by the occurrence of relapsing, painful, deep-seated nodules, abscesses, fistulae, sinus tracts, and scars in the axilla, inguinal area, submammary folds, and perianal area. The disease significantly affects patients’ quality of life and is often associated with severe, debilitating pain and depression. Pro-inflammatory cytokines such as TNF-α, interleukin 17 (IL-17), IL-23, IL-12, IL-1α, and IL-1β play a significant role in the pathogenesis of hidradenitis suppurativa. Treatment is difficult and often ineffective, based on both surgical and pharmacological methods. Biologic drugs in hidradenitis suppurativa are the subject of many clinical trials and may be effective in patients for whom other therapies have failed. The first biological drug approved by the Food and Drug Administration for the treatment of hidradenitis suppurativa was the TNF-α inhibitor — adalimumab. The advancement of knowledge of immune mechanisms in the pathogenesis of hidradenitis suppurativa has allowed the development of clinical trials of new therapeutic targets. In 2023, the Food and Drug Administration (FDA) approved the IL-17 inhibitor — secukinumab as the second biological drug in hidradenitis suppurativa. The aim of this review is an update of the biological treatment and its effectiveness in hidradenitis suppurativa.

Keywords: hidradenitis suppurativabiological treatmentTNF-α inhibitorsIL-17 inhibitorsIL-23 inhibitorsIL-1 inhibitors

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References

  1. Goldburg SR, Strober BE, Payette MJ. Hidradenitis suppurativa: epidemiology, clinical presentation, and pathogenesis. J Am Acad Dermatol. 2020; 82(5): 1045–1058.
    CrossRefPubMed
  2. Cotton CH, Chen SX, Hussain SH, et al. Hidradenitis suppurativa in pediatric patients. Pediatrics. 2023; 151(5): e2022061049.
    CrossRefPubMed
  3. Hernández Montilla I, Medela A, Mac Carthy T, et al. Automatic international hidradenitis suppurativa severity score system (AIHS4): a novel tool to assess the severity of hidradenitis suppurativa using artificial intelligence. Skin Res Technol. 2023; 29(6): e13357.
    CrossRefPubMed
  4. Scala E, Cacciapuoti S, Garzorz-Stark N, et al. Hidradenitis suppurativa: where we are and where we are going. Cells. 2021; 10(8): 2094.
    CrossRefPubMed
  5. Chu YL, Yu S. Hidradenitis suppurativa: an understanding of genetic factors and treatment. Biomedicines. 2024; 12(2): 338.
    CrossRefPubMed
  6. Molinelli E, Gioacchini H, Sapigni C, et al. New insight into the molecular pathomechanism and immunomodulatory treatments of hidradenitis suppurativa. Int J Mol Sci. 2023; 24(9).
    CrossRefPubMed
  7. Markota Čagalj A, Marinović B, Bukvić Mokos Z. New and emerging targeted therapies for hidradenitis suppurativa. Int J Mol Sci. 2022; 23(7): 3753.
    CrossRefPubMed
  8. Martora F, Marasca C, Cacciapuoti S, et al. Secukinumab in hidradenitis suppurativa patients who failed adalimumab: a 52-week real-life study. Clin Cosmet Investig Dermatol. 2024; 17: 159–166.
    CrossRefPubMed
  9. Włodarek K, Ponikowska M, Matusiak Ł, et al. Biologics for hidradenitis suppurativa: an update. Immunotherapy. 2019; 11(1): 45–59.
    CrossRefPubMed
  10. Flood KS, Porter ML, Kimball AB. Biologic treatment for hidradenitis suppurativa. Am J Clin Dermatol. 2019; 20(5): 625–638.
    CrossRefPubMed
  11. Martora F, Megna M, Battista T, et al. Adalimumab, ustekinumab, and secukinumab in the management of hidradenitis suppurativa: a review of the real-life experience. Clin Cosmet Investig Dermatol. 2023; 16: 135–148.
    CrossRefPubMed
  12. Kimball AB, Okun MM, Williams DA, et al. Two phase 3 trials of adalimumab for hidradenitis suppurativa. N Engl J Med. 2016; 375(5): 422–434.
    CrossRefPubMed
  13. Zouboulis CC, Okun MM, Prens EP, et al. Long-term adalimumab efficacy in patients with moderate-to-severe hidradenitis suppurativa/acne inversa: 3-year results of a phase 3 open-label extension study. J Am Acad Dermatol. 2019; 80(1): 60–69.e2.
    CrossRefPubMed
  14. Holcomb ZE, Porter ML, Kimball AB. A safety review of biologic therapies for the management of hidradenitis suppurativa and unmet needs. Expert Opin Drug Saf. 2021; 20(10): 1147–1161.
    CrossRefPubMed
  15. Świerczewska Z, Lewandowski M, Surowiecka A, et al. Immunomodulatory drugs in the treatment of hidradenitis suppurativa-possibilities and limitations. Int J Mol Sci. 2022; 23(17): 9716.
    CrossRefPubMed
  16. Shih T, Lee K, Grogan T, et al. Infliximab in hidradenitis suppurativa: a systematic review and meta-analysis. Dermatol Ther. 2022; 35(9): e15691.
    CrossRefPubMed
  17. Lewandowski M, Świerczewska Z, Barańska-Rybak W. Leczenie biologiczne w hidradenitis suppurativa — przegląd literatury [Biologic treatment for hidradenitis suppurativa — review of current literature]. Forum Derm. 2022; 8(2): 69–75.
    CrossRef
  18. Molinelli E, Sapigni C, Campanati A, et al. Metabolic, pharmacokinetic, and toxicological issues of biologic therapies currently used in the treatment of hidradenitis suppurativa. Expert Opin Drug Metab Toxicol. 2020; 16(11): 1019–1037.
    CrossRefPubMed
  19. Shadid A, Alobaida S, Binamer Y. Certolizumab to treat hidradenitis suppurativa. Dermatol Reports. 2022; 15(2): 9566.
    CrossRefPubMed
  20. van der Zee HH, Prens EP. Failure of anti-interleukin-1 therapy in severe hidradenitis suppurativa: a case report. Dermatology. 2013; 226(2): 97–100.
    CrossRefPubMed
  21. Tursi A. Concomitant hidradenitis suppurativa and pyostomatitis vegetans in silent ulcerative colitis successfully treated with golimumab. Dig Liver Dis. 2016; 48(12): 1511–1512.
    CrossRefPubMed
  22. Ramos FJ, Ruiz RG, Puchades AM. Golimumab, as an alternative treatment in patients with coexisting hidradenitis suppurativa and arthritis after adalimumab failure: report of two cases. Dermatol Ther. 2022; 35(3): e15266.
    CrossRefPubMed
  23. Melendez-Gonzalez MD, Hamad J, Sayed C. Golimumab for the treatment of hidradenitis suppurativa in patients with previous tnf-α treatment failure. J Invest Dermatol. 2021; 141(12): 2975–2979.
    CrossRefPubMed
  24. Adams DR, Yankura JA, Fogelberg AC, et al. Treatment of hidradenitis suppurativa with etanercept injection. Arch Dermatol. 2010; 146(5): 501–504.
    CrossRefPubMed
  25. Fletcher JM, Moran B, Petrasca A, et al. IL-17 in inflammatory skin diseases psoriasis and hidradenitis suppurativa. Clin Exp Immunol. 2020; 201(2): 121–134.
    CrossRefPubMed
  26. Kelly G, Hughes R, McGarry T, et al. Dysregulated cytokine expression in lesional and nonlesional skin in hidradenitis suppurativa. Br J Dermatol. 2015; 173(6): 1431–1439.
    CrossRefPubMed
  27. Schlapbach C, Hänni T, Yawalkar N, et al. Expression of the IL-23/Th17 pathway in lesions of hidradenitis suppurativa. J Am Acad Dermatol. 2011; 65(4): 790–798.
    CrossRefPubMed
  28. Matusiak Ł, Szczęch J, Bieniek A, et al. Increased interleukin (IL)-17 serum levels in patients with hidradenitis suppurativa: Implications for treatment with anti-IL-17 agents. J Am Acad Dermatol. 2017; 76(4): 670–675.
    CrossRefPubMed
  29. Brownstone ND, Hong J, Mosca M, et al. Biologic treatments of psoriasis: an update for the clinician. Biologics. 2021; 15: 39–51.
    CrossRefPubMed
  30. Prussick L, Rothstein B, Joshipura D, et al. Open-label, investigator-initiated, single-site exploratory trial evaluating secukinumab, an anti-interleukin-17A monoclonal antibody, for patients with moderate-to-severe hidradenitis suppurativa. Br J Dermatol. 2019; 181(3): 609–611.
    CrossRefPubMed
  31. Casseres RG, Prussick L, Zancanaro P, et al. Secukinumab in the treatment of moderate to severe hidradenitis suppurativa: Results of an open-label trial. J Am Acad Dermatol. 2020; 82(6): 1524–1526.
    CrossRefPubMed
  32. Reguiaï Z, Fougerousse AC, Maccari F, et al. Effectiveness of secukinumab in hidradenitis suppurativa: an open study (20 cases). J Eur Acad Dermatol Venereol. 2020; 34(11): e750–e751.
    CrossRefPubMed
  33. Ribero S, Ramondetta A, Fabbrocini G, et al. Effectiveness of secukinumab in the treatment of moderate-severe hidradenitis suppurativa: results from an italian multicentric retrospective study in a real-life setting. J Eur Acad Dermatol Venereol. 2021; 35(7): e441–e442.
    CrossRefPubMed
  34. Melgosa Ramos FJ, García Ruiz R, Estébanez Corrales A, et al. Long-term secukinumab efficacy in patients with moderate to severe hidradenitis suppurativa: A retrospective single-centre case series (23 patients). J Eur Acad Dermatol Venereol. 2023; 37(4): e517–e519.
    CrossRefPubMed
  35. Fernandez-Crehuet P, Haselgruber S, Padial-Gomez A, et al. Short-Term effectiveness, safety, and potential predictors of response of secukinumab in patients with severe hidradenitis suppurativa refractory to biologic therapy: a multicenter observational retrospective study. Dermatol Ther (Heidelb). 2023; 13(4): 1029–1038.
    CrossRefPubMed
  36. Kimball AB, Jemec GBE, Alavi A, et al. Secukinumab in moderate-to-severe hidradenitis suppurativa (SUNSHINE and SUNRISE): week 16 and week 52 results of two identical, multicentre, randomised, placebo-controlled, double-blind phase 3 trials. Lancet. 2023; 401(10378): 747–761.
    CrossRefPubMed
  37. Extension study to assess effects of non-interrupted versus interrupted andlong term treatment of two dose regimes of secukinumab in subjects with hidradenitis suppurativa. Identifier: NCT04179175. 2022. https://www.clinicaltrials.gov/study/NCT04179175 (9.06.2024).
  38. Zouboulis CC, Frew JW, Giamarellos-Bourboulis EJ, et al. Target molecules for future hidradenitis suppurativa treatment. Exp Dermatol. 2021; 30 Suppl 1: 8–17.
    CrossRefPubMed
  39. Glatt S, Jemec GBE, Forman S, et al. Efficacy and safety of bimekizumab in moderate to severe hidradenitis suppurativa: a phase 2, double-blind, placebo-controlled randomized clinical trial. JAMA Dermatol. 2021; 157(11): 1279–1288.
    CrossRefPubMed
  40. Kimball AB, Zouboulis CC, Sayed C, et al. Bimekizumab in patients with moderate-to-severe hidradenitis suppurativa: 48-week efficacy and safety from BE HEARD I & II, two phase 3, randomized, double-blind, placebo controlled, multicenter studies. Late-breaking presentation at: American Academy of Dermatology 2023 Annual Meeting, New Orleans, LA, March 17–21, 2023.
  41. Tsai YC, Hung CY, Tsai TF. Efficacy and safety of biologics and small molecules for moderate-to-severe hidradenitis suppurativa: a systematic review and network meta-analysis. Pharmaceutics. 2023; 15(5).
    CrossRefPubMed
  42. Navrazhina K, Frew JW, Grand D, et al. Interleukin-17RA blockade by brodalumab decreases inflammatory pathways in hidradenitis suppurativa skin and serum. Br J Dermatol. 2022; 187(2): 223–233.
    CrossRefPubMed
  43. Frew JW, Navrazhina K, Grand D, et al. The effect of subcutaneous brodalumab on clinical disease activity in hidradenitis suppurativa: an open-label cohort study. J Am Acad Dermatol. 2020; 83(5): 1341–1348.
    CrossRefPubMed
  44. Frew JW, Navrazhina K, Sullivan-Whalen M, et al. Weekly administration of brodalumab in hidradenitis suppurativa: an open-label cohort study. Br J Dermatol. 2021; 184(2): 350–352.
    CrossRefPubMed
  45. Yoshida Y, Oyama N, Iino S, et al. Long-standing refractory hidradenitis suppurativa responded to a brodalumab monotherapy in a patient with psoriasis: A possible involvement of Th17 across the spectrum of both diseases. J Dermatol. 2021; 48(6): 916–920.
    CrossRefPubMed
  46. Arenbergerova M, Arenberger P, Marques E, et al. Successful treatment of recalcitrant gluteal hidradenitis suppurativa with brodalumab after anti-TNF failure. Int J Dermatol. 2020; 59(6): 733–735.
    CrossRefPubMed
  47. Kearney N, Hughes R, Kirby B. Treatment of hidradenitis suppurativa with brodalumab in biologic treatment failures: experiences from a specialty clinic. Clin Exp Dermatol. 2023; 48(7): 790–792.
    CrossRefPubMed
  48. Vagnozzi E, Bruni M, Esposito M, et al. Brodalumab for severe hidradenitis suppurativa: a case of clinico-radiologic improvement and literature review. J Dermatolog Treat. 2023; 34(1): 2270091.
    CrossRefPubMed
  49. Osorio-Gómez GF, Ortiz-Álvarez J, Diaz-Ceca D, et al. Brodalumab for moderate-severe hidradenitis suppurativa: an open-label multicentric cohort study in real clinical practice. Australas J Dermatol. 2024; 65(3): 254–259.
    CrossRefPubMed
  50. Malvaso D, Calabrese L, Chiricozzi A, et al. IL-17 inhibition: a valid therapeutic strategy in the management of hidradenitis suppurativa. Pharmaceutics. 2023; 15(10): 2450.
    CrossRefPubMed
  51. Toussirot E. The IL23/Th17 pathway as a therapeutic target in chronic inflammatory diseases. Inflamm Allergy Drug Targets. 2012; 11(2): 159–168.
    CrossRefPubMed
  52. Rivera-Díaz R, Pozo T, Alfageme F, et al. The effectiveness of guselkumab in patients with hidradenitis suppurativa under clinical practice conditions: a spanish multicentre retrospective study. Actas Dermosifiliogr. 2023; 114(9): 755–762.
    CrossRefPubMed
  53. Martora F, Battista T, Potestio L, et al. Long-Term efficacy of guselkumab in an adolescent hidradenitis suppurativa patients: a case report. Clin Cosmet Investig Dermatol. 2024; 17: 483–487.
    CrossRefPubMed
  54. Repetto F, Roccuzzo G, Burzi L, et al. Drug survival of anti interleukin-17 and interleukin -23 agents after adalimumab failure in hidradenitis suppurativa: a pilot study. Acta Derm Venereol. 2023; 103: adv5278.
    CrossRefPubMed
  55. Kimball AB, Podda M, Alavi A, et al. Guselkumab for the treatment of patients with moderate-to-severe hidradenitis suppurativa: A phase 2 randomized study. J Eur Acad Dermatol Venereol. 2023; 37(10): 2098–2108.
    CrossRefPubMed
  56. Damsin T. A case of concurrent psoriasis and hidradenitis suppurativa successfully treated with tildrakizumab. Dermatol Ther (Heidelb). 2023; 13(7): 1611–1615.
    CrossRefPubMed
  57. Kok Y, Nicolopoulos J, Howard A, et al. Tildrakizumab in the treatment of moderate-to-severe hidradenitis suppurativa. Australas J Dermatol. 2020; 61(4): e488–e490.
    CrossRefPubMed
  58. Kimball AB, Prens EP, Passeron T, et al. Efficacy and safety of risankizumab for the treatment of hidradenitis suppurativa: a phase 2, randomized, placebo-controlled trial. Dermatol Ther (Heidelb). 2023; 13(5): 1099–1111.
    CrossRefPubMed
  59. Repetto F, Burzi L, Ribero S, et al. Efficacy and safety of risankizumab in hidradenitis suppurativa: a case series. Acta Derm Venereol. 2022; 102: adv00780.
    CrossRefPubMed
  60. Benson JM, Peritt D, Scallon BJ, et al. Discovery and mechanism of ustekinumab: a human monoclonal antibody targeting interleukin-12 and interleukin-23 for treatment of immune-mediated disorders. MAbs. 2011; 3(6): 535–545.
    CrossRefPubMed
  61. Grabarek B, Wcisło-Dziadecka D, Mazurek U. Signaling pathways associated with interleukins 12 and 23 and epigenetic mechanism of sequential-specific regulation of expression of related genes by miRNAs as molecular markers for assessing the potential of anti-cytokine therapies. Dermatology Review. 2019; 106(1): 71–80.
    CrossRef
  62. Giatrakos S, Huse K, Kanni T, et al. Haplotypes of IL-12Rβ1 impact on the clinical phenotype of hidradenitis suppurativa. Cytokine. 2013; 62(2): 297–301.
    CrossRefPubMed
  63. Montero-Vilchez T, Pozo-Román T, Sánchez-Velicia L, et al. Ustekinumab in the treatment of patients with hidradenitis suppurativa: multicenter case series and systematic review. J Dermatolog Treat. 2022; 33(1): 348–353.
    CrossRefPubMed
  64. Blok JL, Li K, Brodmerkel C, et al. Ustekinumab in hidradenitis suppurativa: clinical results and a search for potential biomarkers in serum. Br J Dermatol. 2016; 174(4): 839–846.
    CrossRefPubMed
  65. Matusiak Ł, Jemec GBe, Szepietowski JC. Pharmacological development in hidradenitis suppurativa. Curr Opin Pharmacol. 2019; 46: 65–72.
    CrossRefPubMed
  66. Aarts P, Dudink K, Vossen AR, et al. Clinical implementation of biologics and small molecules in the treatment of hidradenitis suppurativa. Drugs. 2021; 81(12): 1397–1410.
    CrossRefPubMed
  67. Leslie KS, Tripathi SV, Nguyen TV, et al. An open-label study of anakinra for the treatment of moderate to severe hidradenitis suppurativa. J Am Acad Dermatol. 2014; 70(2): 243–251.
    CrossRefPubMed
  68. Zarchi K, Dufour DN, Jemec GBE. Successful treatment of severe hidradenitis suppurativa with anakinra. JAMA Dermatol. 2013; 149(10): 1192–1194.
    CrossRefPubMed
  69. Tzanetakou V, Kanni T, Giatrakou S, et al. Safety and efficacy of anakinra in severe hidradenitis suppurativa: a randomized clinical trial. JAMA Dermatol. 2016; 152(1): 52–59.
    CrossRefPubMed
  70. Menis D, Maroñas-Jiménez L, Delgado-Marquez AM, et al. Two cases of severe hidradenitis suppurativa with failure of anakinra therapy. Br J Dermatol. 2015; 172(3): 810–811.
    CrossRefPubMed
  71. Russo V, Alikhan A. Failure of anakinra in a case of severe hidradenitis suppurativa. J Drugs Dermatol. 2016; 15(6): 772–774.
    PubMed
  72. André R, Marescassier H, Gabay C, et al. Long-term therapy with anakinra in hidradenitis suppurativa in three patients. Int J Dermatol. 2019; 58(11): e208–e209.
    CrossRefPubMed
  73. Iznardo H, Puig L. IL-1 family cytokines in inflammatory dermatoses: pathogenetic role and potential therapeutic implications. Int J Mol Sci. 2022; 23(16): 9479.
    CrossRefPubMed
  74. Jaeger T, Andres C, Grosber M, et al. Pyoderma gangrenosum and concomitant hidradenitis suppurativa — rapid response to canakinumab (anti-IL-1β). Eur J Dermatol. 2013; 23(3): 408–410.
    CrossRefPubMed
  75. Houriet C, Seyed Jafari SM, Thomi R, et al. Canakinumab for severe hidradenitis suppurativa: preliminary experience in 2 cases. JAMA Dermatol. 2017; 153(11): 1195–1197.
    CrossRefPubMed
  76. Akdogan N, Yalici-Armagan B, Dogan S, et al. Severe hidradenitis suppurativa (acne inversa) associated with focal segmental glomerulosclerosis and gout partially responsive to canakinumab. Dermatol Ther. 2021; 34(4): edth15002.
    CrossRefPubMed
  77. Sun NZ, Ro T, Jolly P, et al. Non-response to interleukin-1 antagonist canakinumab in two patients with refractory pyoderma gangrenosum and hidradenitis suppurativa. J Clin Aesthet Dermatol. 2017; 10(9): 36–38.
    PubMed
  78. Tekin B, Salman A, Ergun T. Hidradenitis suppurativa unresponsive to canakinumab treatment: a case report. Indian J Dermatol Venereol Leprol. 2017; 83(5): 615–617.
    CrossRefPubMed
  79. Hickish T, Andre T, Wyrwicz L, et al. MABp1 as a novel antibody treatment for advanced colorectal cancer: a randomised, double-blind, placebo-controlled, phase 3 study. Lancet Oncol. 2017; 18(2): 192–201.
    CrossRefPubMed
  80. Gottlieb A, Natsis NE, Kerdel F, et al. A phase II open-label study of bermekimab in patients with hidradenitis suppurativa shows resolution of inflammatory lesions and pain. J Invest Dermatol. 2020; 140(8): 1538–1545.e2.
    CrossRefPubMed
  81. Kanni T, Argyropoulou M, Spyridopoulos T, et al. MABp1 targeting IL-1α for moderate to severe hidradenitis suppurativa not eligible for adalimumab: a randomized study. J Invest Dermatol. 2018; 138(4): 795–801.
    CrossRefPubMed

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