From the Guidelines
The most effective treatment for reoccurring hidradenitis suppurativa is adalimumab, 160 mg at week 0,80 mg at week 2, and then 40 mg weekly starting at week 4, as evidenced by the significant improvement in Hidradenitis Suppurativa Clinical Response (HiSCR) at 12 weeks compared to placebo 1. When considering treatment options for hidradenitis suppurativa, it's crucial to prioritize approaches that reduce morbidity, mortality, and improve quality of life.
Treatment Approaches
- For mild to moderate cases, topical treatments and oral antibiotics may be sufficient, but for more severe or recurrent cases, biologics like adalimumab have shown promising results 1.
- The use of adalimumab has been studied extensively, including in the PIONEER 1 and PIONEER 2 trials, which demonstrated significant improvements in HiSCR at 12 weeks compared to placebo 1.
Key Considerations
- The dosage of adalimumab is critical, with a loading dose of 160 mg at week 0, followed by 80 mg at week 2, and then 40 mg weekly starting at week 4, as this regimen has shown the most significant efficacy in clinical trials 1.
- It's also important to note that almost half of the week 12 responders lost response at week 36 despite weekly maintenance dosing, highlighting the need for ongoing treatment and monitoring 1.
Additional Recommendations
- Lifestyle modifications, such as wearing loose clothing, maintaining good hygiene, and avoiding shaving affected areas, can also help reduce the risk of recurrence and improve quality of life.
- Surgical options may be necessary for persistent or severe cases, but should be considered on a case-by-case basis.
From the FDA Drug Label
Hidradenitis Suppurativa (HS) (1.8): treatment of moderate to severe hidradenitis suppurativa in patients 12 years of age and older. Hidradenitis Suppurativa (2. 6): Adults:◦ Day 1: 160 mg (given in one day or split over two consecutive days)◦ Day 15: 80 mg ◦ Day 29 and subsequent doses: 40 mg every week or 80 mg every other week
The best treatment for reoccurring hidradenitis suppurativa, according to the drug label, is adalimumab (HUMIRA). The recommended dosage for adults is:
- 160 mg on Day 1 (given in one day or split over two consecutive days)
- 80 mg on Day 15
- 40 mg every week or 80 mg every other week starting on Day 29 2
From the Research
Treatment Options for Hidradenitis Suppurativa
The treatment of hidradenitis suppurativa (HS) can be challenging and often requires a multimodal approach with the use of on- and off-label medications 3. The current treatment options for HS include:
- Topical therapies
- Systemic and topical antibiotics
- Retinoids
- Hormonal and metabolic therapies
- Biologics and small molecule inhibitors
- Systemic immunosuppressants
- Surgical treatment
- Pain management
- Lifestyle modifications
- Adjunctive treatment
- Wound care
- Flare therapy
Medical Treatment
Medical treatment for HS typically involves the use of antibiotics, retinoids, antiandrogens, immunosuppressive and anti-inflammatory agents, and radiotherapy for early lesions 4. Adalimumab, an anti-tumor necrosis factor antibody, has been shown to be effective in reducing the Sartorius score and pain in patients with HS 4.
Surgical Treatment
Surgery is often necessary for intractable disease presenting in the late stages, and can involve simple excision or complete local excision followed by skin graft 4.
Combination Therapies
Combination therapies, such as antibiotics and hyperbaric oxygen therapy, have shown promising results, but further randomized trials are needed to confirm these findings 4.
Factors Affecting Treatment Response
High body mass index (BMI) and smoking habits have been found to be predictive factors of a poor response to antibiotics 5.
Recommended Treatments
Based on the quality of evidence, the most recommended treatments for HS include adalimumab and laser therapy 4. The combination of oral clindamycin with rifampicin is also recommended as a first-line treatment in moderate-to-severe HS 5.