A recent study published in the Journal of the American Academy of Dermatology has found that combining adalimumab, the only approved biologic for hidradenitis suppurativa (HS), with surgery can lead to better clinical outcomes and improved quality of life for patients with moderate to severe HS.
Hidradenitis suppurativa is a chronic inflammatory skin disease characterized by painful nodules, abscesses, and draining tunnels, typically occurring in the armpits, groin, and anogenital regions. The symptoms of HS, including pain, itching, malodor, and suppuration, can significantly impact a patient’s quality of life.
The aim of the study was to compare the clinical effectiveness of adalimumab combined with surgery versus adalimumab alone in patients with moderate to severe HS. The researchers conducted a pragmatic randomized controlled trial at the Erasmus University Medical Center in Rotterdam, the Netherlands, from August 2018 to July 2022.
The study included 31 patients in each arm, and the primary outcome measured was the difference in the mean International Hidradenitis Suppurativa Severity Score System (IHS4) decrease after 12 months of treatment. The secondary outcome was the difference in the mean Dermatology Life Quality Index decrease.
After 12 months of treatment, the group receiving combined adalimumab and surgery showed a significantly greater reduction in the IHS4 score compared to the group receiving adalimumab alone. The surgery group also had a higher reduction in the Dermatology Life Quality Index.
The researchers noted that the monotherapy group had a high proportion of inflammatory lesions persisting after 3 months of treatment, highlighting the need for additional surgery. The combination therapy of adalimumab and surgery led to significant improvements in both clinical outcomes and quality of life for patients.
However, the study noted that recurrences can still occur after surgery, with a recurrence rate of 10% observed in this study. The follow-up period of the study was deemed too short to evaluate surgical recurrence rates.
The researchers emphasized that the option of combining adalimumab with surgery should be considered for patients with moderate to severe HS. Full remission of draining tunnels should be the goal, as residual skin inflammation can trigger the development of new lesions.
This study provides evidence supporting the use of combined treatment for HS patients, combining adalimumab with surgery to achieve better clinical outcomes and improve patients’ quality of life.
Aarts P, van Huijstee JC, van der Zee HH, van Doorn MBA, van Straalen KR, Prens EP. Adalimumab in conjunction with surgery compared with adalimumab monotherapy for hidradenitis suppurativa: a randomized controlled trial in a real-world setting. J Am Acad Dermatol. 2023;89(4):677-684. doi:10.1016/j.jaad.2023.04.034