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Low prescription of TNF-α inhibitors in hidradenitis suppurativa

Key clinical point: Tumor necrosis alpha (TNF-α) inhibitors (adalimumab and infliximab [Ada/Ifx]) prescribing was very low in patients with hidradenitis suppurativa (HS), including those with a dermatology relationship.

Major finding: Overall, 1.8% of patients with HS received prescription for Ada/Ifx. Only 17.8% of patients had an established dermatology relationship. Ada/Ifx prescription was highest (6%) among those with dermatology care. Patients with established dermatology had 6.93 times the odds of Ada/Ifx prescription vs. those without (P less than .001).

Study details: This cross-sectional analysis estimated the percentage of HS patients (n=25,966) receiving prescription for Ada/Ifx and determined associated characteristics.

Disclosures: Dr. Orenstein’s participation was supported in part by the Building Interdisciplinary Research Careers in Women’s Health of the National Institutes of Health. He is an investigator for Chemocentryx. Dr. Garg is an advisor for AbbVie, Amgen, Boehringer Ingelheim, Incyte, Janssen, Novartis, Pfizer, UCB, and Viela Bio and receives research grants from AbbVie and National Psoriasis Foundation.


“This cross-sectional study utilizing the Explorys database found that use of evidence-based biologic therapies (specifically, adalimumab and infliximab) for treatment of HS was lower than expected (only 1.8% of patients). While the database does not allow for differentiation between mild, moderate, and severe hidradenitis, prior work suggests approximately one-third of patients with HS have moderate-to-severe disease. Based on treatment guidelines, anti-TNF therapy is recommended in such patients, so the extent of underutilization of these agents is striking. Even among the 17.8% of patients treated by dermatologists, only 6% received prescriptions for adalimumab or infliximab.

Therefore, relatively few patients with HS are under the care of dermatologists, and even those who are likely are undertreated in many cases. As the authors point out, undertreatment of HS increases the risk of disease progression, pain, drainage, and flare. The authors’ findings therefore identify an important practice gap in the management of patients with moderate to severe hidradenitis suppurativa.”

Robert G. Micheletti, MD

Assistant Professor of Dermatology and Medicine

Perelman School of Medicine, University of Pennsylvania

Garg A, Neuren E, Cha D, et al. Evaluating Patients’ Unmet Needs in Hidradenitis Suppurativa: results from the Global VOICE project. J Am Acad Dermatol. 2019;82(2):366-76.
Garg A, Lavian J, Strunk A. Low Utilization of the Dermatology Ambulatory Encounter among Patients with Hidradenitis Suppurativa: A Population-Based Retrospective Cohort Analysis in the USA. Dermatology. 2017;233(5):396-8.


Orenstein LAV et al. J Am Acad Dermatol. 2020 Aug 3. doi: 10.1016/j.jaad.2020.07.108.