A 50% increase in clinical trials between 2017 and 2019, devoted to reducing symptoms of hidradenitis supperativa, may be a first-line option for Stage 2 and Stage 3 patients.
Hidradenitis Suppurativa (HS), also known in the European areas as Acne Inversa (AI), is a chronic, non-contagious, painful and quality of life impacting skin disease that causes boils to form in the folds of the skin and has a profound impact on quality of life.
But, according to Joslyn Kirby, M.D., a dermatologist with PennState Health Milton S. Hershey Medical Center, the number of clinical trials investigating the efficacy of biologics in treating this condition at Stage 2 and Stage 3 are growing in number and should be considered a front-line treatment option.
“The challenge occurs if a patient has inferior responsiveness to adalimumab,” she said. “They must go through a three-month wash-out period before participating in a clinical trail.”
Kirby discussed current and emerging hidradenitis suppurativa treatment options during the recent Fall Clinical Dermatology Conference in Las Vegas.
Options are different for patients with Stage 2 and Stage 3 disease. Stage 2 patients experience nodules, abscesses, sinus tracts, fistula and scarring, and Stage 3 patients can develop multiple fines tracts, fistulas, and scars throughout an entire area.
For these individuals, if a clinical trial isn’t available, Kirby said, dermatologists can try the same medical and surgical therapies available to Stage-1 patients, but they can also add in infliximab and ustekinumab as third-line medical options. She noted that interlesional steroid injections and punch de-roofing can be effective first-line options for Stage 2 disease, but recommended dermatologists pursue localized and regional excisions for Stage 3 patients who need surgical intervention.
Overall, Dr. Kirby said, it’s important for dermatologists to consider a combination of surgical and medical options when treating hidradenitis patients. And, whenever possible, she suggested providers begin pursuing a clinical trial as a potential first-line treatment method for patients who have Stage 2 or Stage 3 disease.
“Any tunnel formation—whether it’s one or multiples—indicates that a clinical trial is a great opportunity for people who haven’t received a biologic therapy before,” she said. “It’s a chance for them to get effective treatment, and an FDA-approved therapy is available later if it doesn’t work.”