Systematic review of the efficacy and adverse events associated with infliximab treatment of hidradenitis suppurativa in patients with coexistent inflammatory diseases
2013; Elsevier BV; Volume: 69; Issue: 4 Linguagem: Inglês
10.1016/j.jaad.2013.04.032
ISSN1097-6787
AutoresL. Machet, M. Samimi, M. Delage, Gilles Paintaud, A. Maruani,
Tópico(s)Microscopic Colitis
ResumoTo the Editor: Hidradenitis suppurativa (HS) is a chronic suppurative disease located on areas rich in apocrine glands.1Canoui-Poitrine F. Revuz J.E. Wolkenstein P. Viallette C. Gabison G. Pouget F. et al.Clinical characteristics of a series of 302 French patients with hidradenitis suppurativa, with an analysis of factors associated with disease severity.J Am Acad Dermatol. 2009; 61: 51-57Abstract Full Text Full Text PDF PubMed Scopus (204) Google Scholar Treatment is often disappointing. The efficacy of infliximab (IFX) was first suggested in patients with both HS and Crohn’s disease (CD). This was further confirmed in other patients with no associated disease,2Rambhatla P.V. Lim H.W. Hamzavi I. A systematic review of treatments for hidradenitis suppurativa.Arch Dermatol. 2012; 148: 439-446Crossref PubMed Scopus (82) Google Scholar, 3Blok J.L. van Hattem S. Jonkman M.F. Horváth B. Systemic therapy with immunosuppressive agents and retinoids in hidradenitis suppurativa: a systematic review.Br J Dermatol. 2013; 168: 243-252Crossref PubMed Scopus (98) Google Scholar, 4van Rappard DC, Limpens J, Mekkes JR. The off-label treatment of severe hidradenitis suppurativa with TNF-α inhibitors: a systematic review. J Dermatolog Treat doi: 10.3109/09546634.2012.674193. Published online April 12, 2012.Google Scholar including 1 randomized trial against placebo.5Grant A. Gonzalez T. Montgomery M.O. Cardenas V. Kerdel F.A. Infliximab therapy for patients with moderate to severe hidradenitis suppurativa: a randomized, double-blind, placebo-controlled crossover trial.J Am Acad Dermatol. 2010; 62: 205-217Abstract Full Text Full Text PDF PubMed Scopus (329) Google Scholar Our aim was to address the question of the efficacy and safety of IFX in a subgroup of patients with HS and associated inflammatory disease. We carried out a systematic review from January 1, 2000, to December 31, 2011. The key words used were “hidradenitis suppurativa,” “acne inversa,” “Verneuil’s disease,” and “infliximab” on PubMed, Embase, and the Google Scholar database. In the initial step, all abstracts were read and all studies published in English, German, Dutch, Italian, Spanish, Portuguese, and French were extracted, provided that the abstract or the title mentioned that at least 1 patient had been treated with IFX for HS, Verneuil disease, or acne inversa. We checked that the selected series did not contain duplicates originating from the same authors or even from different authors. A total of 122 patients in 39 publications were selected, all of them resistant to conventional treatment. Inflammatory diseases were reported in 22 cases in association with HS treated with IFX: CD 11 cases (9%); pyoderma gangrenosum 5 cases; ankylosing spondylitis 3 cases; ulcerative colitis, SAPHO syndrome, and psoriasis each 1 case (Table I). Treatment of these inflammatory diseases prescribed before starting IFX was mainly azathioprine, methotrexate, corticosteroids, or antibiotics. These drugs were sometimes continued during IFX therapy (antibiotics n = 9, immunosuppressive agents n = 10, corticosteroids n = 7). In nearly all cases 5 mg/kg/d of IFX was administered intravenously at weeks 0, 2, and 6. The prevalence of adverse events in this subgroup of patients was lower but not statistically different from the prevalence of adverse events in patients with HS and no associated disease (3/22 vs 29/100, P = .14). The numbers of treatment failure were twice high but were not statistically different (6/22 [27%] vs 13/100 [13%], P = .10).Table IComorbidity and concomitant treatments of patients with hidradenitis suppurativa and associated inflammatory disease, treated with infliximabArticlesCDPGUCPsoriasisASSAPHO∗Synovitis-acne-pustulosis-hyperostosis-osteitis. syndromeEfficacyMartinez et al. Inflamm Bowel Dis 2001;7:323-6.11Katsanos et al. Am J Gastroenterol 2002;97:2155-6.11Roussomoustakaki et al. J Gastroenterol 2003;38:1000-4.11Adams et al. Arch Dermatol 2003;139:1540-2.11Rosi et al. J Dermatolog Treat 2005;16:58-61.11Suys and D'Heygere. Ned Tijdschr Dermatol Venereol 2005;15:406-7.10Usmani et al. Clin Exp Dermatol 2007;32:204-5.111Moschella. Int J Dermatol 2007;46:1287-91.21†PG associated with CD.3Fernández-Vozmediano and Armario-Hita. Dermatology 2007;215:41-4.11Kwan and Chong. Hong Kong J Dermatol Venereol 2008;16:206-10.11Goertz et al. Med Sci Monit 2009;15:CS14-8.10Poulin. J Cutan Med Surg 2009;13:221-5.11Deschamps et al. Ann Dermatol Venereol 2010;137:546-50.11Yazdanyar et al. Acta Dermatovenerol Alp Panonica Adriat 2010;19:23-5.21Garcia-Rabasco et al. Actas Dermosifiliogr 2010;101:717-21.11De Souza et al. Bull NYU Hosp Jt Dis 2011;69:185-7.11Hsiao et al. Arch Dermatol 2010;146:1265-70.20Total (n)115113116AS, Ankylosing spondylitis; CD, Crohn's disease; PG, pyoderma gangrenosum; UC, ulcerative colitis.∗ Synovitis-acne-pustulosis-hyperostosis-osteitis.† PG associated with CD. Open table in a new tab AS, Ankylosing spondylitis; CD, Crohn's disease; PG, pyoderma gangrenosum; UC, ulcerative colitis. Although not statistically significant, our study is the first to suggest that the combination of HS with inflammatory diseases (CD, pyoderma gangrenosum, ankylosing spondylitis, SAPHO syndrome, and psoriasis) is associated with poorer response of HS to IFX. The efficacy of IFX in HS was first demonstrated in patients with HS and CD. This probably explains the overrepresentation of CD in the systematic review (9%). These patients had previously been treated with corticosteroids, antibiotics, and immunosuppressive agents for the inflammatory disease, with no sufficient improvement. This may have meant that more severe or recalcitrant forms of HS were selected. On the other hand, concurrent treatment with corticosteroids and antibiotics may have contributed to the smaller number and lesser severity of adverse events. Controlled studies are needed to define the risk/benefit ratio and the respective places of IFX, adalimumab, ustekinumab, methotrexate, cyclosporine, antibiotics, and surgery in the treatment of HS, particularly in the group of patients with HS and another inflammatory disease.2Rambhatla P.V. Lim H.W. Hamzavi I. A systematic review of treatments for hidradenitis suppurativa.Arch Dermatol. 2012; 148: 439-446Crossref PubMed Scopus (82) Google Scholar, 3Blok J.L. van Hattem S. Jonkman M.F. Horváth B. Systemic therapy with immunosuppressive agents and retinoids in hidradenitis suppurativa: a systematic review.Br J Dermatol. 2013; 168: 243-252Crossref PubMed Scopus (98) Google Scholar, 4van Rappard DC, Limpens J, Mekkes JR. The off-label treatment of severe hidradenitis suppurativa with TNF-α inhibitors: a systematic review. J Dermatolog Treat doi: 10.3109/09546634.2012.674193. Published online April 12, 2012.Google Scholar, 5Grant A. Gonzalez T. Montgomery M.O. Cardenas V. Kerdel F.A. Infliximab therapy for patients with moderate to severe hidradenitis suppurativa: a randomized, double-blind, placebo-controlled crossover trial.J Am Acad Dermatol. 2010; 62: 205-217Abstract Full Text Full Text PDF PubMed Scopus (329) Google Scholar
Referência(s)