PracticeUpdate Dermatology Best of 2018

Secukinumab Improves Symptoms of Moderate-to-Severe Hidradenitis Suppurativa CONFERENCE COVERAGE 34

The IL-17A inhibitor secukinumab has been shown to improve hidradenitis suppurativa symptoms. S ecukinumab has been demonstrated to improve hidradenitis suppurativa symptoms and quality of life when dosed either every 2

An average of 7 weeks were needed to achieve HiSCR. Of the 18 enrolled patients, 8 (44%) achieved HiSCR during the loading dose period. Sartorius score decreased an average of 28% (95% CI 8–49%) from baseline (P = .008). Scores on the Dermatology Life Quality Index decreased an average of 3.6 (95% CI 0.5–6.7) points (P = .04), or 26% (95% CI 5–47%), P = .04. A total of 9 patients (50%) experienced a ≥5-point drop in score on the Dermatology Life Quality Index. The drug was well tolerated at both dosing frequen- cies. The most common side effects were upper respiratory infection and diarrhea. No patients devel- oped inflammatory bowel disease during the study. Dr. Rosmarin explained that hidradenitis suppura- tiva is a difficult-to-treat inflammatory skin condition that significantly decreases patients’ quality of life. Hidradenitis suppurativa can be treated successfully with anti-tumor necrosis factor biologics. The cause of hidradenitis suppurativa is not known. Increased circulating IL-17 and T-helper 17 cell activity in active lesions is hypothesized to contribute to the pathogenesis of hidradenitis suppurativa. When IL-17A is removed from the skin, in ammation is reduced and may even disappear. The monoclo- nal antibody secukinumab binds to and destroys IL-17A. Hidradenitis suppurativa primarily affects the inter- triginous skin of the axillary, inguinal, genital, and perianal areas. It is characterized by recurrent inflamed nodules and abscesses, resulting in fistulas, fibrosis, and scarring. The prevalence of hidradenitis suppurativa is approximately 1%. Secukinumab was the first anti-IL-17A biologic to be approved for psoriasis by the FDA and European Medicines Agency. Treatment with subcutaneous secukinumab (300 mg) once every week followed by once every 4 weeks has shown convincing results for psoriasis. Despite a lack of consensus on the role of IL-17 in the pathogenesis of hidradenitis suppurativa, Matusiak et al demonstrated increased IL-17 serum levels in patients with the disorder in 2017. Kelly et al demon- strated mRNA expression in lesional skin of patients with hidradenitis suppurativa in 2015. Dr. Rosmarin concluded that secukinumab was demonstrated to improve hidradenitis suppurativa symptoms and quality of life when dosed either every 2 or 4 weeks. Secukinumab warrants further study for hidradenitis

or every 4 weeks. This finding of an interim analy- sis of a 28-week open-label trial was reported at EADV 2018. David Rosmarin, MD, of Tufts Medical Center, Bos- ton, Massachusetts, and colleagues set out to investigate the efficacy of two dosing frequencies of secukinumab for moderate to severe hidradeni- tis suppurativa. “Hidradenitis suppurativa,” Dr. Rosmarin told Elsevi- er’s PracticeUpdate , is often a devastating disease with patients in considerable pain. Yet the disorder is underrecognized.” He continued, “While dermatologists are familiar with secukinumab for psoriasis, secukinumab has not yet been studied systematically for hidradenitis suppurativa. Adalimumab is the only FDA-approved medication for hidradenitis suppurativa, and having additional therapeutic options would be a major step forward for our patients.” A total of 18 patients withmoderate-to-severe hidrade- nitis suppurativa received subcutaneous secukinumab 300 mg administered weekly for 4 weeks, then every 2 or 4 weeks for an additional 24 weeks. The primary objective is the proportion of patients who achieved a Hidradenitis Suppurativa Clinical Response (HiSCR) after 24 weeks of the drug. Sec- ondary objectives include the change in Sartorius score and Dermatology Life Quality Index. Overall, 9 patients enrolled in every-4-week dosing. Of these patients, 7 completed the therapy through week 12, and 4 completed it through week 24. A total of 9 patients enrolled for every-2-week dosing. Of these patients, 9 have completed therapy through week 12, and 6 through week 24. Overall, 3 patients remain active in the study. Enrolled patients were 50% male, an average of 33 years of age, and weighed 103 kg. The average duration of disease was 12 years. A total of 14 patients (78%) exhibited baseline Hurley stage 3; 4 patients (22%), stage 2. Mean Sartorius score was 166 and baseline score on the Dermatol- ogy Life Quality Index was 12. Overall, 6 patients (33%) had failed previous anti-tumor necrosis factor therapy. With both dosing regimens, 7 of 9 patients (78%) achieved HiSCR based on the last recorded observation. Of 10 patients who completed therapy through week 24, 8 (80%) achieved HiSCR. Of the 6 patients who had failed previous anti-tumor necrosis factor ther- apy, 5 (83%) achieved HiSCR.

Dr. David Rosmarin

suppurativa in larger trials. www. practiceupdate.com/c/73851

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