Adalimumab improves hidradenitis suppurativa outcomes among obese patients

For overweight and obese individuals with moderate to severe hidradenitis suppurativa (HS), an increased adalimumab dosage may be linked to better results, says an article published in Journal of Drugs in Dermatology. 

A solitary licenced medication for the crippling chronic inflammatory condition hidradenitis suppurativa is the TNF-antagonist adalimumab 40 mg/week (ADA40). In phase 3 studies, only 50% of patients receiving ADA40 experienced a Hidradenitis Suppurativa Clinical Response (HiSCR).1 We believe that insufficient dose may be contributing to the drug's low efficacy. Adalimumab dose is not weight-based, in contrast to other TNF-inhibitors, even though HS patients are 4-times more likely than the general population to be obese. 8 overweight and obese HS patients with ADA40-refractory illness participated in this trial by Jazzmin Williams and colleagues to assess the efficacy of adalimumab 80 mg/week (ADA80).

Patients treated with ADA40 and seen between August 2016 and December 2021 in this dual-center retrospective cohort trial with an ICD-10 diagnosis for HS were evaluated for dosage escalation to ADA80. Patients qualified for inclusion if they scored moderate or severe on the Hurley or HS-Physician Global Assessment (HS-PGA), had a BMI of 25 or above, and had received ADA80 treatment for at least three months. At ADA40 and ADA80, information was gathered on demographics, comorbidities, therapies, adverse events, patient-reported symptoms, and the severity of HS (HS-PGA and HiSCR). Wilcoxon signed-rank test comparisons and descriptive statistics are reported. The Kaiser Permanente Northern California Institutional Review Board was not required to approve this study because it was authorized by the University of California, San Francisco Institutional Review Board (IRB).

The key findings of this study were:

Eight individuals were administered ADA80 who had a median BMI of 36.6 (IQR 32.5-40.7) and no improvement in the severity of their HS on ADA40. 

Improvements in the HS-Physician Global Assessment were noted in the patients (ADA40: median 3.0 (3.0-3.8); ADA80: (2.0 (1.8, 2.0)) (P=0.01)), the HS Clinical Response was attained in all 5 patients with confirmed lesion counts, and all 8 patients reported better symptomatology.

Reference:

Jazzmin Williams, Akhil Wadhera, Haley Naik, & Claudia Guzik. Increased doses of adalimumab are associated with clinical improvement of Hidradenitis Suppurativa - JDDonline - Journal of Drugs in dermatology.