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Italian Journal of Dermatology and Venereology 2021 Jun 23

DOI: 10.23736/S2784-8671.21.07049-3


language: English

Flares as dynamic predictive factor of response to adalimumab in hidradenitis suppurativa, real-life data

Raffaele D. CAPOSIENA CARO 1 , Andrea CHIRICOZZI 2, Andrea SECHI 3, Elisa MOLINELLI 4, Marina VENTURINI 5, Eleonora CANDI 6, Dalma MALVASO 2, Ketty PERIS 2, Annalisa PATRIZI 3, Annamaria OFFIDANI 4, Piergiacomo CALZAVARA-PINTON 5, Luca BIANCHI 1

1 Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy; 2 Institute of Dermatology, Università Cattolica - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; 3 Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy; 4 Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy; 5 Department of Dermatology, University of Brescia at ASST-Spedali Civili, Brescia, Italy; 6 Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy


BACKGROUND: Hidradenitis suppurativa (HS) is characterized by periodic worsening of both clinical manifestations and symptoms. The aim was to investigate the role of flare outbreak as a possible predictive factor of response to Adalimumab.
METHODS: 115 HS patients in treatment with adalimumab, with moderate-severe HS, ≥3 abscesses and inflammatory-nodules (ANs) from 5 Italian centers were included in this retrospective analysis. The information about gender, ages at onset/baseline, therapeutic delay, family history, body mass index, smoking, comorbidities, phenotypes, body areas, severity indexes at baseline was collected. Baseline characteristics, total number and timeline of flares were analysed by regression and survival analysis with Hidradenitis Suppurativa Clinical Response (HiSCR).
RESULTS: During the observational period, 80.9% of patients developed flares, detecting 252 flares. Univariate model identified five factors associated with the absence of response: age (p-value=0.020), comorbidities (p-value=0.030), genital-perineal involvement (pvalue= 0.004), no response at week-12 (p-value=0.027), and flares outbreak (p-value=0.010). Joint analysis of recurrent and terminal events showed a positive correlation between flare recurrence and no-response (p-value<0.001). Among the identified variables associated with poor response to the therapy: occurrence of a flare before week-12 was the one with the highest risk of no response (p-value<0.001). The limitations are: study’s retrospective design, limited number of patients, absence either of a consensus about flare definition, placebo control group or standard therapy of flares during adalimumab therapy.
CONCLUSIONS: The analysis of a “dynamic” variable, as flares evaluation together with an appropriate clinical baseline assessment can be a useful approach to predict the middle-long-term response to adalimumab.

KEY WORDS: Hidradenitis suppurativa; Flares; Predective factors; Adalimumab; Guidelines

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