High rate of non- or partial responders jeopardises therapeutic success in HS

A real-world study revealed that in daily practice more than half of the patients with hidradenitis suppurativa (HS) show only a partial response when treated with adalimumab. Consequently, partial/non-responders still have a significant burden of disease and it has a higher impact on their quality-of-life.

The TNF-blocker adalimumab was approved for HS following the positive results of the phase 3 PIONEER I (NCT01468207) and II (NCT01468233) trials. But is this biologic also effective in daily practice, where patients differ markedly from those included in clinical trials? To address this issue, Dr Hayley Wallinger (Adelphi Real World, UK) and her team examined the real-world data drawn from the Adelphi HS Disease Specific Programme (adelphirealworld.com), 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 2021 [1].

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 had moderate-to-severe disease at the initiation of the treatment. Participants were analysed in 2 groups based on their subjective disease severity: currently mild (responders) versus currently moderate-to-severe (partial/non-responders; PNRES). Out of the 401 participants, 148 were PNRES.

The analysis revealed that a higher proportion of PNRES (62.8%) were in a more severe disease state at the initiation of a biologic than the responders were (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’s 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. Wallinger H, 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.

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Posted on 5 November, 202216 February, 2024