Anti-IL17 blockade leads to maintained pain reduction in patients with HS

Pain reduction in patients with hidradenitis suppurativa (HS) on secukinumab was numerically greater with the IL-17 blocker than on placebo in a pooled analysis from 2 phase 3 trials. Over 65% of patients with moderate/severe pain at baseline experienced a reduction to mild/no pain after 1 year. 

Dr John Ingram (Cardiff University, UK) presented a post-hoc analysis of the phase 3 SUNSHINE (NCT03713619) and SUNRISE (NCT03713632) trials that focused on pain ameliorations with secukinumab for HS treatment [1]. Previously, the 2 identical trials found superiority of the secukinumab over placebo as HS treatment for a bi-weekly dosing with 300 mg at week 16 [1,2]. A 4-weekly dosing that had also been assessed was significant only in the SUNRISE trial [2].

In both trials, pain was measured by the Patient’s Global Assessment (PGA) of skin pain on a numeric rating scale (NRS) [1]. Using a mixed effects model accounting for multiple testing, the current analysis evaluated changes in skin pain at its worst in different categories of intensity: no pain (NRS 0), mild pain (NRS >0–≤6), moderate pain (NRS >6–≤8), and severe pain (NRS >8). SUNSHINE and SUNRISE included over 1,000 participants with a mean age of 36.2 years, 56.3% were women, and the mean baseline pain was NRS 5.2.

At week 16, secukinumab numerically decreased pain in comparison to placebo: bi-weekly dosing NRS -1.4, 4-weekly dosing NRS -1.1 versus placebo NRS -0.5. These pain ameliorations were continued to week 52, with a numerically greater decrease on secukinumab bi-weekly (NRS -1.8) than 4-weekly (NRS -1.5).

Looking at reductions after 1 year by pain category, 8.3% of the participants on bi-weekly secukinumab with moderate pain and 8.6% with severe pain at baseline achieved a status of no pain. Also, 63.3% and 45.7% of these groups experienced a reduction to mild pain, respectively. After dividing the participants into those with NRS >6 and NRS≤6, 65.3% (bi-weekly dosing) and 70.1% (4-weekly dosing) of those with moderate/severe pain at baseline had mild/no pain after 52 weeks.

In their conclusion, the authors added that secukinumab treatment also entailed a decreased use of pain medication over time and an improvement in quality of life.

1. 
   
   1. Ingram JR, et al. Secukinumab provides sustained improvements in pain in patients with moderate to severe hidradenitis suppurativa: A post-hoc analysis of the SUNSHINE and SUNRISE phase 3 trials. P0045, EADV Congress 2023, 11–14 October, Berlin, Germany.
   2. Kimball AB, et al. Lancet. 2023;401:747–61.

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Posted on 28 November, 202322 February, 2024