2023 Virtual Grand Rounds Session 6: May 3, 2023 - Navigating the Challenges of Diagnosis and Management of Hidradenitis Suppurativa

Hidradenitis Suppurativa

WEDNESDAY, May 3, 2023 -- For patients with moderate-to-severe hidradenitis suppurativa (HS), adalimumab combined with surgery yields greater clinical effectiveness and improved quality of life after 12 months compared with adalimumab alone, according to a study published online April 26 in the Journal of the American Academy of Dermatology.Pim Aarts, M.D., from the Erasmus University Medical Center in Rotterdam, Netherlands, and colleagues compared the clinical effectiveness of adalimumab combined with surgery versus adalimumab monotherapy among patients with moderate-to-severe HS in a pragmatic randomized trial. Thirty-one patients were included in each of the arms. The difference in mean International HS Severity Score System (IHS4) reduction after 12 months of treatment was assessed as the primary outcome.After 12 months of treatment, the researchers observed a significantly greater reduction in IHS4 for the surgery group versus the monotherapy group (–19.1 ± 11.3 versus –7.8 ± 11.8). A greater reduction was also seen in the Dermatology Life Quality Index after treatment in the surgery group versus the monotherapy group (–8.2 ± 6.2 versus –4.0 ± 7.7)."The combination of adalimumab with surgery showed significantly greater clinical effectiveness and improvement in quality of life than adalimumab monotherapy, with a higher rate of patient satisfaction," the authors write. "The therapeutic option of adalimumab with surgery should always be proposed to patients with moderate-to-severe hidradenitis suppurativa."

Greater reduction seen in International HS Severity Score System and in Dermatology Life Quality Index in combination group

Adalimumab Plus Surgery Better for Hidradenitis Suppurativa

WEDNESDAY, April 26, 2023 -- The Hidradenitis Suppurativa Investigator Global Assessment (HS-IGA) score has good psychometric properties compared with existing measures, according to a study published online April 26 in JAMA Dermatology.Amit Garg, M.D., from the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell in New Hyde Park, New York, and colleagues assessed psychometric properties of the HS-IGA score using a clinical trial dataset. Trial participants with moderate-to-severe HS were randomly assigned to receive bimekizumab, adalimumab, or placebo. The HS-IGA score was measured at prespecified time points up to 12 weeks after randomization.The researchers found that at baseline and week 12, the HS-IGA score showed strong convergent validity with the International Hidradenitis Suppurativa Severity Score System and HS Physician Global Assessment (HS-PhGA) scores. Good test-retest reliability was seen for the HS-IGA score assessed during predosing visits at screening and baseline (intraclass correlation coefficient, 0.92). HS-IGA responders were significantly associated with Hidradenitis Suppurativa Clinical Response (HiSCR-50/75/90) responders at week 12. At week 12, the HS-IGA score was predictive of HiSCR-50/75/90 and of HS-PhGA (areas under the curve, 0.69, 0.73, 0.85, and 0.71, respectively). Low predictive validity with patient-reported outcomes at week 12 was seen for the HS-IGA as a measure of disease activity."The HS-IGA demonstrated good psychometric properties compared with existing measures and may be considered for use as an end point in clinical trials for HS," the authors write. "The HS-IGA represents a valuable clinician-reported outcome to drug development efforts on behalf of patients with HS."Several authors disclosed financial ties to the pharmaceutical industry; one author holds patents, including for the HS-IGA.

Tool has good psychometric properties compared with existing measures

 Validity Demonstrated for Hidradenitis Suppurativa Investigator Global Assessment

Many patients with hidradenitis suppurativa (HS) are dissatisfied with treatment, according to a study published in the December issue of the
 
 British Journal of Dermatology
 
 .




 Bria Midgette, from the Donald &amp; Barbara Zucker School of Medicine at Hofstra Northwell in Hempstead, New York, and colleagues measured associations between treatment satisfaction and clinical and treatment-related characteristics among 1,418 patients with HS recruited from 27 institutions in 14 countries from October 2017 to July 2018. Patients' self-reported overall satisfaction with their current treatments for HS, rated from very dissatisfied to very satisfied on a 5-point scale, was reported.




 The researchers found that 45 percent of patients were either dissatisfied or very dissatisfied with their current medical treatment. In an adjusted analysis, the odds of being satisfied with current treatment were increased for patients primarily treated by a dermatologist for HS versus those not primarily treated by a dermatologist (odds ratio, 1.99). Higher satisfaction was seen in association with treatment with biologics relative to treatment with nonbiologic systemic medications (odds ratio, 2.36). Lower treatment satisfaction was seen in association with smoking (active versus never: odds ratio, 0.78), depression (odds ratio, 0.69), increasing number of comorbidities (odds ratio, 0.88 per comorbidity), and increasing flare frequency.




 "These results may imply low awareness around the role of dermatologists in the care of patients with HS, as well as highlighting the difficulty in accessing dermatologists," the authors write.




 Several authors disclosed financial ties to the pharmaceutical industry.




 <a class="rm-stats-tracked" href="https://onlinelibrary.wiley.com/doi/10.1111/bjd.21798" target="_blank">
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Odds of being satisfied with treatment increased for patients primarily treated by a dermatologist

Many Hidradenitis Suppurativa Patients Dissatisfied With Treatment

Many patients with hidradenitis suppurativa (HS) with an index emergency department visit for HS return to the emergency department, while few have follow-up dermatology visits, according to a study published online Oct. 26 in
 
 JAMA Dermatology
 
 .




 Cynthia X. Wang, M.D., from the Washington University School of Medicine in St. Louis, and colleagues conducted a retrospective cohort study involving 20,269 patients with HS to examine interventions and patient factors associated with emergency department return following an initial emergency department visit.




 Of the patients, 48.0 percent had incision and drainage performed at the index emergency department visit; 72.6 and 48.9 percent received an oral antibiotic prescription and an opioid medication prescription, respectively. The researchers found that 17.2 percent of patients had at least one return emergency department visit within 30 days for HS or proxy compared with 2.4 percent who had a dermatology visit. Within 180 days, 34.0 percent of patients had a return emergency department visit for HS or proxy, while 6.8 percent had a dermatology visit. The likelihood of returning to the emergency department for treatment was increased for patients with Medicaid and for those with an opioid prescription (odds ratios, 1.48 and 1.48, respectively, within 180 days); in contrast, these patients were less likely to have dermatology follow-up (odds ratios, 0.16 and 0.81, respectively, within 180 days).




 "This study highlights a critical gap in care for patients with HS because a majority of these patients who present to the emergency department do not make it into the ambulatory dermatology setting for follow-up," the authors write.




 Several authors disclosed financial ties to the pharmaceutical industry.




 <a class="rm-stats-tracked" href="https://jamanetwork.com/journals/jamadermatology/fullarticle/2797839" target="_blank">
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17.2 percent of patients had at least one return emergency department visit within 30 days, while 2.4 percent had a dermatology visit

Return to ED Common for Hidradenitis Suppurativa Patients

The burden of ambulatory hidradenitis suppurativa (HS) visits is higher during the late spring and summer months (May to August), according to a research letter published online Sept. 12 in
 
 SKIN
 
 .




 Terri Shih, from the David Geffen School of Medicine at the University of California Los Angeles, and colleagues examined the seasonal trends of ambulatory visits for patients with HS using data from the National Ambulatory Medical Care Survey. A total of 2.33 million outpatient visits with a diagnosis of HS were identified between 2008 and 2018.




 The researchers found that about 21, 51, and 28 percent of visits occurred during winter to early spring (January to April), late spring to summer (May to August), and autumn (September to December), respectively. Between these time periods, the number of visits differed significantly. In multivariate analyses, no significant differences were observed in visit number during these months based on gender, race, region, insurance status, or whether the provider was a dermatologist.




 "Our findings can help dermatologists anticipate a higher burden of HS management during late spring and summer months to help ensure continued access to care and address potential season-related HS triggers such as hyperhidrosis early," the authors write.




 Several authors disclosed financial ties to the biopharmaceutical industry.




 <a class="rm-stats-tracked" href="https://jofskin.org/index.php/skin/article/view/1679" target="_blank">
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51 percent of ambulatory visits for hidradenitis suppurativa occurred during May to August

Burden of Ambulatory Hidradenitis Suppurativa Visits Up During Summer

The prevalence of depression is increased among pediatric and adult patients with hidradenitis suppurativa (HS), according to a study published in the January issue of the
 
 Journal of the American Academy of Dermatology
 
 .




 Shari Wright, from the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell in Hempstead, New York, and colleagues compared the prevalence of depression in a cross-sectional analysis of 38,140 adults and 1,162 pediatric HS patients and controls.




 The researchers found that the prevalence of depression was 30.0 and 16.9 percent among adults with HS and controls, respectively, and 11.7 and 4.1 percent, respectively, among children/adolescents with HS and controls. Relative to controls, the odds of having depression were 1.26 (95 percent confidence interval, 1.25 to 1.28; P &lt; 0.001) and 1.42 (95 percent confidence interval, 0.999 to 2.01; P = 0.051) among adults and children/adolescents with HS, respectively, in adjusted analyses.




 "Prevalence of depression among pediatric and adult patients with HS is high," the authors write. "Health care providers should be attentive to signs and symptoms of depression among children, adolescents, and adult patients with HS. Periodic screening for depression may be considered."




 One author disclosed financial ties to the pharmaceutical industry.




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Prevalence of depression increased among adults and children with hidradenitis suppurativa

Depression Up in Pediatric, Adult Hidradenitis Suppurativa Patients

In Episode 34, host James Q. Del Rosso, DO sits down with Joslyn Sciacca Kirby, MD, MEd, MS, to discuss Hidradenitis Suppurativa and the difficulty that they, along with many Dermatologists, face in treating it.

In Episode 34 of&nbsp;Derms and Conditions, our host James Q. Del Rosso, DO sits down with Joslyn Sciacca Kirby, MD, MEd, MS, who is an Associate Professor of Dermatology at Penn State Health. The two discuss Hidradenitis Suppurativa and the difficulty that they, along with many Dermatologists, face in treating it. They begin by pointing out all of the treatment modalities that have historically been used and how some are still effective, while others should be retired, especially when facing severe or refractory disease. Dr.&nbsp;Kirby&nbsp;then shares some of her preferred topical and systemic therapies and how to select the right drug for the right patient. Finally, she relays that there is hope for the future in treating HS, as she personally participates in clinical trials for new monoclonal antibodies that have shown promising results. You don&rsquo;t want to miss this episode filled with pearls on treating one of the most stubborn dermatologic conditions. FINANCIAL DISCLOSURES JAMES DEL ROSSO, DO: CONSULTANT/ADVISOR Abbvie, Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), BioFrontera, BioPharmX, Bristol-Myers-Squibb, Cassiopea, Dermata, Dermavant, Encore, EPI Health, Evommune, Ferndale, Galderma, Incyte, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), MC2, Novan, Pfizer, Regeneron, Sanofi-Genzyme, SolGel, Sonoma (IntraDerm), Sun Pharma, Trevi, UCB, Verrica, Vyne (Foamix; Menlo) SPEAKER BUREAU Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), EPI Health, Ferndale, Galderma, Genentech, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), Pfizer, Regeneron, Sanofi-Genzyme, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo) RESEARCH INVESTIGATOR Aclaris, Almirall, Amgen, Anaptys Bio, Arcutis, Athenex, Bausch Health (Ortho Dermatology), BioPharmX, Biorasi, Botanix, Brickell, Cara Therapeutics, Cassiopea, Dermavant, EPI Health, Ferndale, Galderma, Incyte, Leo Pharma, Lilly (Dermira), Novan, Pfizer, Ralexar, Regeneron, SolGel, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo). Joslyn R. Sciacca Kirby, MD, MEd SPEAKER AbbVie GRANTS Incyte CONSULTANT AbbVie, Bayer, ChemoCentryx, InflaRx, Janssen, Moonlake, Novartis, UCB

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2023 Virtual Grand Rounds Session 6: May 3, 2023 - Navigating the Challenges of Diagnosis and Management of Hidradenitis Suppurativa