Is Remicade (infliximab) used to treat hidradenitis suppurativa?

Infliximab (Remicade) for Hidradenitis Suppurativa

Infliximab (Remicade) is not a first-line treatment for hidradenitis suppurativa but can be considered as an alternative biologic therapy for moderate-to-severe cases that have failed standard treatments.

Treatment Algorithm for Hidradenitis Suppurativa

First-Line Treatments

• For mild disease (Hurley I):

  • Topical therapies (clindamycin 1% solution, antiseptic washes)
  • Tetracyclines (doxycycline 100mg twice daily) for 12 weeks 1

• For moderate disease (Hurley II):

  • Clindamycin 300mg orally twice daily with rifampicin 600mg orally once daily for 10-12 weeks 1
  • If inadequate response, adalimumab is recommended 1

• For severe disease (Hurley III):

  • Adalimumab (160mg at week 0, 80mg at week 2, then 40mg weekly) is the first-line biologic therapy 1

Role of Infliximab (Remicade)

Infliximab is not mentioned in the current treatment guidelines as a first-line therapy for hidradenitis suppurativa 1. However, research evidence suggests it may be effective in certain scenarios:

• Studies have shown that infliximab can be effective for severe extensive forms of hidradenitis suppurativa when used as monotherapy 2
• Dosing typically ranges from 5-10 mg/kg at weeks 0,2, and 6, followed by maintenance dosing 2, 3
• Research indicates that a higher dose of 10 mg/kg every 6-8 weeks may be more effective than standard dosing 3
• Infliximab has demonstrated efficacy in reducing the number of involved sites, decreasing flares, and improving quality of life in patients with moderate-to-severe disease 4

Comparative Efficacy

When comparing treatment options:

• One study directly compared infliximab and adalimumab, finding that infliximab (5 mg/kg at weeks 0,2, and 6) performed better than adalimumab (40 mg every other week) in reducing disease severity 5
• The Sartorius score (a measure of disease severity) was reduced to 54% of baseline with infliximab versus 66% with adalimumab 5

Important Considerations

• Response to infliximab can be variable, with some patients showing significant improvement while others experience minimal benefit 6
• Dose escalation is commonly required, with 64% of patients needing increased dosing within the first year of treatment 3
• Most patients who achieve stable dosing do so at 10 mg/kg every 6-8 weeks 3
• Common side effects include minor infections, and patients should be monitored for tuberculosis prior to initiating therapy 4

Clinical Pearls

• Consider infliximab for patients who have failed or cannot tolerate adalimumab
• Higher doses (10 mg/kg) may be more effective than standard dosing (5 mg/kg)
• Regular monitoring for adverse effects is essential
• Surgical options should still be considered alongside medical therapy for appropriate cases
• Treatment response should be evaluated after approximately 12 weeks

While infliximab shows promise for hidradenitis suppurativa treatment, it should be reserved for cases that have failed standard therapies including adalimumab, which is the only FDA-approved biologic for this condition.