A systematic review reports that the drug survival of biologics in hidradenitis suppurativa is comparatively shorter than that of biologics for other dermatological conditions.
Drug survival is a measure of the tolerability and efficacy of different treatment regimens. It is described by the proportion of patients who remain on the given treatment regimen over a period of time.
In this systematic review and meta-analysis, published in the Journal of the American Academy of Dermatology, the authors explored the drug survival metrics of biologics utilized by hidradenitis suppurativa (HS) patients.
Study Characteristics
A total of seven studies were included in the quantitative analysis. The total number of participants was 1,170, with the majority being female (63%) and bio-naïve (58%). Tumor necrosis factor (TNF)-α inhibitors were the most utilized biologics in the HS patients (91%). Due to a high risk of bias, the authors excluded one study from the meta-analysis. Compared to patients treated with interleukin (IL)-17 and IL-23 inhibitors, HS patients treated with TNF-α inhibitors were more bio-naïve.
Drug Survival in Hidradenitis Suppurative Patients
The median drug survival in the HS patients was 11.9 months, and this was comparable between TNF-α and non-TNF-α inhibitors. The drug survival was significantly longer in biologic-naïve patients compared to those who had been exposed to biologics previously (p = 0.003).
Reasons for Treatment Cessation
The reasons for discontinuation of treatment included the lack of efficacy of biologics and drug-related side effects. The authors reported lower discontinuation rates attributed to the adverse effects of non-TNF-α inhibitors.
Treatment Cessation and Loss of Response to Biologics
The meta-analysis indicates that approximately 50% of the HS patients receiving biologics will stop the treatment by 12 months. The 12-month drug survival rates, however, are higher for biologics in patients with atopic dermatitis and psoriasis. The HS patients may discontinue the treatment due to loss of response; however, some patients reported treatment cessation in the absence of loss of response.
Reasons for Short Drug Survival of Biologics in Hidradenitis Suppurativa
The mechanisms underlying shorter drug survival of biologics in HS patients include the development of anti-drug antibodies or the upregulation of immune-mediated pathways. Prior exposure to biologics can also contribute to shorter drug survival.
In summary, the drug survival of HS is relatively shorter than that of other dermatological conditions, which is associated with treatment discontinuation due to the loss of response, as reported by HS patients.
Source:
Pham, J. P., Rosenø, N. a. L., Roccuzzo, G., Saal, R. C., Egeberg, A., Ring, H. C., & Frew, J. W. (2024). Drug Survival of Biologics in Hidradenitis Suppurativa: A Systematic Review and Meta-Analysis. Journal of the American Academy of Dermatology. https://doi.org/10.1016/j.jaad.2024.03.028
