Biologic survival in hidradenitis suppurativa: much done, more to do

Linked Article: Prens et al. Br J Dermatol 2021; 185:177–184. Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease, with multiple systemic comorbidities1 Treatment challenging and adalimumab [tumour necrosis factor (TNF)-α monoclonal antibody] the only licensed therapy. It effective in approximately 50% of patients, based on Suppurativa Clinical Response results from phase III trials PIONEER I II.2 In this issue, report real-world drug survival data for infliximab HS.3 Until now, long-term therapy was available 3-year open label extension (OLE) II trials. This showed sustained response 52·3% to week 168 using last observation carried forward analysis.4 Subsequent post hoc analysis found, however, dropout rate 51 out 88 patients OLE study.5 trial do not always reflect daily clinical practice,6 hence studies such as one by colleagues3 are important. The 148 who had at least 6 months’ follow-up, implying partial primary response, reported. 12 24 months 56·3% 30·5% respectively, 58·3% 48·6% respectively. main reason discontinuation loss efficacy. Older age, longer disease duration, higher body mass index (BMI) more severe were associated survival. differs factors that influence biologic other conditions. total, 56·8% all underwent surgery excluding incision drainage. Surgery during treatment predicted univariate Cox regression analysis. Although stated authors it reasonable assume those disease.7 beneficial effects study may have influenced results. recognized BMI increased HS severity.8 positive explain part counterintuitive findings comparisons across groups should be done caution, identifies lower anti-TNF-α than seen psoriasis, rheumatology gastroenterology cohorts. Concomitant additional immunosuppressants methotrexate azathioprine common positively also worth noting 62·2% taking concomitant medications HS, most frequently antibiotics. use antibiotics need illustrates therapies alone sufficient control majority. well but retrospective design. highlights multifaceted approach people where treatment, needed. Prospective real-life registry required further understand natural history therapeutic interventions continue recent significant advances we thank Dr Rosalind Hughes, St Vincent’s University Hospital, providing critical review commentary. Open access funding provided IReL. Roisin Hambly: Formal (equal); Writing-original draft Writing-review & editing (equal). Brian Kirby: Conceptualization Supervision