From the Guidelines
Ozanimod and risankizumab are not currently recommended for the treatment of hidradenitis suppurativa (HS) due to insufficient clinical evidence supporting their use in this condition. Ozanimod, a sphingosine-1-phosphate receptor modulator approved for multiple sclerosis and ulcerative colitis, could potentially help HS by reducing inflammatory cell trafficking to affected areas 1. Risankizumab, an IL-23 inhibitor approved for psoriasis and Crohn's disease, might benefit HS patients given the role of the IL-23/IL-17 axis in HS pathogenesis 1. However, standard HS treatments remain antibiotics (such as tetracyclines, clindamycin-rifampin combination), anti-androgens, retinoids, and biologics like adalimumab (the only FDA-approved biologic for HS) 1.
Key Considerations
- The use of ozanimod and risankizumab in HS is not supported by current clinical guidelines due to lack of evidence 1.
- Adalimumab is the only FDA-approved biologic for HS, with studies demonstrating its efficacy in reducing symptoms and improving quality of life 1.
- Patients with HS should work with dermatologists experienced in treating this condition to explore established treatment options before considering experimental therapies 1.
- Any off-label use of these medications would require careful consideration of potential benefits versus risks, appropriate dosing protocols from their approved indications, and thorough monitoring for adverse effects 1.
Treatment Approach
- The treatment of HS should be based on a comprehensive approach, including medical and surgical management, as well as lifestyle modifications 1.
- The use of patient-reported outcomes, such as the Dermatology Life Quality Index (DLQI), is recommended to assess the impact of treatment on quality of life 1.
- A therapeutic algorithm, informed by evidence-based guidelines, should be used to guide treatment decisions 1.
From the Research
Treatment of Hidradenitis Suppurativa with Ozanimod and Risankizumab
- There is no mention of ozanimod in the provided studies as a treatment for Hidradenitis Suppurativa (HS) 2, 3, 4, 5, 6.
- Risankizumab, on the other hand, has been studied as a potential treatment for HS. A phase 2, randomized, placebo-controlled trial evaluated the efficacy and safety of risankizumab for the treatment of HS, but the primary endpoint was not met, and the study was terminated early 6.
- Another study reviewed the existing trials and real-life data on anti-IL23 (including risankizumab) in HS, and found that while real-life experiences showed positive data, the existing Phase 2 studies suggested that these drugs may be useful only for a subgroup of patients with HS whose features need to be elucidated 4.
- The current treatments for HS include topical therapy, systemic treatments, biological agents, surgery, and light therapy, with adalimumab being the only US Food and Drug Administration (FDA) approved biologic agent for moderate-to-severe HS 2, 3, 5.
Efficacy and Safety of Risankizumab
- The phase 2 trial of risankizumab for HS found that the incidence of treatment-emergent adverse events (TEAEs), severe TEAEs, TEAEs considered possibly related to study drug, and TEAEs leading to discontinuation of study drug were generally low and comparable across treatment groups 6.
- However, the study concluded that risankizumab does not appear to be an efficacious treatment for moderate-to-severe HS 6.
Future Directions
- Further studies are needed to understand the complex molecular mechanisms underlying HS pathogenesis and develop improved therapies 6.
- The development of new therapeutic targets, such as anti-IL23, may provide alternative treatment options for patients with HS who do not respond to current treatments 4.