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Hidradenitis suppurativa: Induction therapy with intravenous ustekinumab may be beneficial

Key clinical point: Half of the patients with hidradenitis suppurativa (HS) treated with an intravenous infusion of ustekinumab achieved clinical response, without experiencing any drug-related adverse effects.

Major finding: At 12 weeks, 50% of the patients achieved Hidradenitis Suppurativa Clinical Response. There were no adverse effects reported during the follow-up period.

Study details: Prospective evaluation of outpatients with refractory HS visiting the dermatology department of a hospital in Valencia, Spain, who were treated with a single intravenous induction dose of ustekinumab followed by a subcutaneous maintenance regime.

Disclosures: No funding information available. The authors declared no conflicts of interest.

Commentary

“This small prospective study investigated the efficacy of ustekinumab for management of severe, Hurley stage III hidradenitis suppurativa in patients who previously failed adalimumab and other therapies. Among six patients receiving ustekinumab, 3 achieved clinical response by HiSCR by week 12. Notable in this cohort was the dosing regimen, which included an intravenous induction dose, followed by 90mg injected subcutaneously every 8 weeks as maintenance therapy.

With only six patients included, it is difficult to draw any conclusions from the results reported in this study. Other data supporting the use of ustekinumab for HS are limited to small (fewer than 20 patients), uncontrolled studies. These similarly show response by HiSCR in roughly 50% of patients, along with improvement in measures of pain and quality-of-life.

Little evidence is currently available to guide the dosing regimen for ustekinumab in HS. Anecdotally, higher dose and frequency of medication administration (e.g., a maintenance regimen of 90mg every 6-8 weeks instead of every 12 weeks) may be more effective. Similarly, it is possible intravenous induction may be beneficial, but larger controlled studies are needed. Ustekinumab may be an attractive option in those patients with comorbid inflammatory bowel disease and hidradenitis, since it may be effective therapy for both diseases.”

Robert G. Micheletti, MD

Assistant Professor of Dermatology and Medicine

Perelman School of Medicine, University of Pennsylvania

References:
Romani J, Vilarrasa E, Martorell A, et al. Ustekinumab with intravenous infusion: results in hidradenitis suppurativa. Dermatology. 2020;26(1):21-24
Blok JL, Li K, Brodmerkel C, et al. Ustekinumab in Hidradenitis suppurativa: clinical results and a search for potential biomarkers in serum. Br J Dermatol. 2016 Apr;174(4):839-46

Citation:

Sánchez-Martínez EM et al. Dermatol Ther. 2020 Jul 23. doi: 10.1111/dth.14054.