“Looking at biologics beyond TNF blockade, I will concentrate on IL-1α, ß and the possible role of IL-17 and IL-23,” said Prof. Brian Kirby (St. Vincent’s University Hospital, Ireland) [1]. He emphasised that unlike in psoriasis, clinical trials will mostly show very high placebo response rates; one of the reasons that HS studies can be more difficult to interpret. In a not yet published phase 2 study without a placebo control group, bermekimab targeting IL-1α led to a positive Hidradenitis Suppurativa Clinical Response (HiSCR) at week 12 in 61% of the TNF-naïve patients [1,2]. A placebo-controlled phase 2 study of anakinra, an IL-1 receptor antagonist showed 78% HiSCR response at week 12 for the anakinra group vs 30% for placebo (P=0.04).
Focusing on the Th17-pathway, a phase 3 study is already planned for secukinumab; although the results of the phase 2 study have not yet been published. A small case series showed improvement with secukinumab and 4 individual case reports stated successful treatment with this agent [1,3-7]. “The first real evidence that we have seen to date that suggested that IL-17 blockade may be useful, comes from an RCT testing the new molecule CMJ112,” said Prof. Kirby. 66 patients of Hurley stage 2 or 3 were randomised to receive either CJM112 300 mg subcutaneously or placebo [8]. Primary endpoint was a decrease in HS physician global assessment (PGA) at week 16. It was met by 32% with CMJ112 and 13% with placebo (see Figure). There was a decrease in inflammatory lesions of 56% vs 30%. For IL-23 inhibition with guselkumab a phase 2 study is ongoing. Furthermore, IFX-1, an anti-complement factor C5a antibody, achieved HiSCR in 83% at day 50, but the study only comprised 12 adults and there was a significant number of adverse events [1,9]. “There are multiple potential targets for biological therapy of HS, but RCTs seem to be difficult and this may have to do with the disease itself,” told Prof. Kirby. “Until now there is a paucity of good evidence, but several phase 2 trials are still ongoing,” he concluded.
Figure: HS-PGA responder rate (primary endpoint) by treatment group up to week 16 [8]
- Kirby B. 24th World Congress of Dermatology, 10-15 June 2019, Milan, Italy.
- XBiotech. Press release: Friday, May 31, 2019.
- Prussick L, et al. Br J Dermatol. 2019 Feb 22. [Epub ahead of print]
- Giuseppe P, et al. Ann Dermatol. 2018;30:462-464.
- Jørgensen AR, et al. Case Rep Dermatol Med. 2018;2018:8685136.
- Schuch A, et al. Acta Derm Venereol. 2018;98:151-152.
- Thorlacius L, et al. Br J Dermatol. 2018;179:182-185.
- Kimball AB, et al. ePoster 24th World Congress of Dermatology, 10-15 June 2019, Milan, Italy.
- Argyropoulou M, et al. P0043 presented at EADV 2017, Geneva, Switzerland.
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Table of Contents: WCD 2019
Featured articles
Letter from the Editor
Insights into pathogenesis of AD define novel therapeutic targets
Treating Psoriasis in 2019
Choosing the right biologic in psoriasis
Registries – an important research tool in biologics
Atopic Dermatitis – What is New
Insights into pathogenesis of AD define novel therapeutic targets
Combinations are hot in AD treatment
Dermal Reactions to Systemic Drugs
Cutaneous adverse events due to EGFR inhibitors
Management strategies for drug-induced mucositis
Skin toxicity of immune checkpoint inhibitors
Lupus Erythematosus Today
New targets and biologics for cutaneous lupus erythematosus
Novel lupus classification will aid future research
Hidradenitis Suppurativa
Various guidelines with much overlap
Antibiotics in hidradenitis suppurativa
Biologicals beyond TNF blockade
Small Molecules – What to Expect
Novel treatment options for many dermatologic indications
Long awaited oral therapy for moderate-to-severe AD
Novel treatment options in alopecia areata and vitiligo
Optimising the Management of Keloids
Keloids: a faulty switch in wound healing?
What the future of keloid treatment could hold
Malignant Melanoma – Advances in Management
Will malignant melanoma become a curable disease?
Best of the Posters
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