Biologic therapy in HS patients: unmet needs due to high rate of non-responders

Biologics were recently approved for hidradenitis suppurativa, but many patients who do not respond efficiently experience a significant disease burden.

Recent approval: biologic therapy effectiveness needs further evaluation

HS is a chronic inflammatory skin disease characterised by recurrent outbreaks of skin lesions that can lead to permanent scarring in the absence of prompt treatment. The recent approval of adalimumab has introduced biologic therapy, yet its effectiveness needs further evaluation.

To address this issue, Dr Hayley Wallinger (Adelphi Real World, United Kingdom) and her team examined the real-world data drawn from the Adelphi HS Disease Specific Programme, a point-in-time survey of physicians and their consulting HS patients conducted in the USA, France, Germany, Italy, Spain, and the United Kingdom between November 2020 and April 20211. Physicians provided clinical characteristics, treatment history, and disease stage, whereas patients completed a questionnaire that included details on quality-of-life and work productivity. "We aimed to assess ongoing unmet needs among HS patients receiving biologic therapy," Dr Wallinger explained. 

The team selected the patients receiving a biologic for at least 16 weeks and were moderate-to-severe at the initiation of the treatment and analysed them in 2 groups based on current subjective severity: currently mild (responders) versus currently moderate-to-severe (partial/non-responders; PNRES). Out of the 401 patients, 148 were PNRES.

Dissatisfaction with patients HS control in an important % of PNRES

The analysis revealed that a higher proportion of PNRES (62.8%) were in a more severe state at the initiation of a biologic than the responders (38.7%; P<0.0001). The mean number of symptoms currently experienced was significantly higher in PNRES compared with responders (4.6 vs 2.0; P<0.0001), as were the number of body areas affected and the proportion of patients showing flares. Similarly, a higher proportion of PNRES experienced physician-reported general pain/discomfort, restricted/painful limb movements, pain on sitting, inflammation, and drainage.

Physicians expressed their dissatisfaction with patients' current HS control in 46.0% of those in the PNRES group compared with 5.9% in the responders group (P<0.0001). Patients who were considered PNRES reported significantly worse Health-related quality-of-life (HRQoL) and Work Productivity and Activity Index (WPAI) due to HS.

This high degree of unmet needs in PNRES observed in this survey suggests the necessity of novel treatments with a better response, which may reduce the burden of moderate-to-severe HS.

  1. Hayley Wallinger, et al. Unmet needs among hidradenitis suppurativa patients receiving biologic therapy in the United States of America and Europe by response status: Analysis of a real-world dataset. P0035, EADV Congress 2022, Milan, Italy, 7–10 September.