Interruption of oral clindamycin plus rifampicin therapy in patients with hidradenitis suppurativa: An observational study to assess prevalence and causes
2019; Elsevier BV; Volume: 80; Issue: 5 Linguagem: Inglês
10.1016/j.jaad.2018.12.043
ISSN1097-6787
AutoresLuca Schneller‐Pavelescu, Eduardo Vergara‐de Caso, A. Martorell, J. Romaní, Mireya Lázaro, Eva Vilarrasa, B. Díaz-Ley, I. Vázquez‐Osorio, Juan Manuel Segura Palacios, José Manuel Azaña Defez, Marcos A. González‐López, Javier Cañueto, Alejandro Molina‐Leyva, María Leiva-Salinas, F.J. Navarro‐Triviño, José Sánchez‐Payá, J.C. Pascual,
Tópico(s)Colorectal and Anal Carcinomas
ResumoTo the Editor: Combination therapy with oral clindamycin, 300 mg twice daily, plus rifampicin, 300 mg twice daily or 600 mg once daily, for 10 weeks is among the keystone treatments for moderate-to-severe hidradenitis suppurativa (HS).1Zouboulis C.C. Desai N. Emtestam L. et al.European S1 guideline for the treatment of hidradenitis suppurativa/acne inversa.J Eur Acad Dermatol Venereol. 2015; 29: 619-644Crossref PubMed Scopus (677) Google Scholar Since 2006, 6 small studies involving a total of 178 patients have investigated the efficacy of this antibiotic combination.2Gener G. Canoui-Poitrine F. Revuz J.E. et al.Combination therapy with clindamycin and rifampicin for hidradenitis suppurativa: a series of 116 consecutive patients.Dermatology. 2009; 219: 148-154Crossref PubMed Scopus (206) Google Scholar, 3van der Zee H.H. Boer J. Prens E.P. Jemec G.B. The effect of combined treatment with oral clindamycin and oral rifampicin in patients with hidradenitis suppurativa.Dermatology. 2009; 219: 143-147Crossref PubMed Scopus (179) Google Scholar, 4Dessinioti C. Zisimou C. Tzanetakou V. Stratigos A. Antoniou C. Oral clindamycin and rifampicin combination therapy for hidradenitis suppurativa: a prospective study and 1-year follow-up.Clin Exp Dermatol. 2016; 41: 852-857Crossref PubMed Scopus (34) Google Scholar Most of the studies had a retrospective design, and only 1 reported safety outcomes.4Dessinioti C. Zisimou C. Tzanetakou V. Stratigos A. Antoniou C. Oral clindamycin and rifampicin combination therapy for hidradenitis suppurativa: a prospective study and 1-year follow-up.Clin Exp Dermatol. 2016; 41: 852-857Crossref PubMed Scopus (34) Google Scholar The prevalence of treatment interruption ranged from 9.1% to 28.6% (mean, 16.3%), and the rate of appearance of adverse events ranged from 9.1% to 38.3% (mean, 21.9%).2Gener G. Canoui-Poitrine F. Revuz J.E. et al.Combination therapy with clindamycin and rifampicin for hidradenitis suppurativa: a series of 116 consecutive patients.Dermatology. 2009; 219: 148-154Crossref PubMed Scopus (206) Google Scholar, 3van der Zee H.H. Boer J. Prens E.P. Jemec G.B. The effect of combined treatment with oral clindamycin and oral rifampicin in patients with hidradenitis suppurativa.Dermatology. 2009; 219: 143-147Crossref PubMed Scopus (179) Google Scholar, 4Dessinioti C. Zisimou C. Tzanetakou V. Stratigos A. Antoniou C. Oral clindamycin and rifampicin combination therapy for hidradenitis suppurativa: a prospective study and 1-year follow-up.Clin Exp Dermatol. 2016; 41: 852-857Crossref PubMed Scopus (34) Google Scholar The most common adverse events were gastrointestinal (GI) disturbances (diarrhea, vomiting, abdominal pain, and dyspepsia), followed by cutaneous rash, vaginitis, nonspecific pain, and arthralgia. A better understanding of the reasons for poor adherence and adverse events associated with treatment may help dermatologists to better advise patients, potentially allowing prevention of some side effects. We designed a descriptive, observational, retrospective multicentric study to determine the prevalence of interruption of clindamycin plus rifampicin before 10 weeks in patients with HS. A retrospective chart review was performed; included were patients who were at least 18 years old, had Hurley stage II or III HS, and were receiving clindamycin plus rifampicin for the first time. Patients simultaneously receiving other systemic therapies for HS were excluded. We enrolled 509 patients from 14 Spanish hospitals (Table I); 135 of them (26.5%) interrupted antibiotic treatment. We did not observe differences between the proportions of men (26.6%) and women (26.5%) who interrupted their treatment. After dividing the study population into quartiles by age (≤30 years, n = 133; 31-38 years, n = 127; 39-49 years, n = 125; and ≥50 years, n = 124), we observed that older age was associated with interruption of treatment. The odds ratio (OR) for treatment interruption in patients aged 50 or older versus patients in the youngest age group was 1.9 (95% confidence interval [CI], 1.1-3.3; P = .03). Ever-smokers had 1.5 times the odds of interrupting their treatment as compared with never-smokers (95% CI, 1.1-2.1; P = .02). In multivariable analysis, these associations remained significant (for smoking: OR, 1.7; 95% CI, 1.0-2.7; P = .033; for age ≥50: OR, 1.8; 95% CI, 1.0-2.7; P = .048). We did not observe any association between treatment interruption and any other feature (Table II). There were 182 adverse effects in 145 patients (28.5%), the most frequent being GI disturbances (n = 108 [21.2%]), followed by nonspecific aches or pains (n = 19 [3.7%]) and mucocutaneous Candida albicans infections (n = 12 [2.4%]). None of the patients with GI disturbances presented with Clostridium difficile colitis, and all responded well to conservative management. No association between adverse events and any of the demographic or disease characteristics considered was observed.Table IDemographic characteristics of enrolled patients according to Hurley stage of HS, with treatment interruption and adverse events ratesCharacteristicTotalHurley stageP valueII∗Hurley stage II: recurring boils in multiple areas with scarring and sinus tracts.III†Hurley stage III: widespread boils with multiple interconnected tracts across the affected area, with no normal-appearing skin left between them.All patients, n (%)509378 (74.2)131 (25.8)Female, n (%)272 (53.4)215 (57)57 (43.5).008Male, n (%)237 (46.6)163 (43)74 (56.5)Median age, y (IQR)38 (30-49)36 (28-47)45 (36-54)<.001BMI (kg/m2), n (%) <25133 (26.1)92 (24.3)41 (31.3).17 ≥25344 (67.6)259 (68.5)85 (64.9) Unknown32 (6.3)27 (7.1)5 (3.8)Ever-smoker, n (%)360 (70.7)268 (70.9)92 (70.2).88Median age at onset of HS, y (IQR)20 (16-29)20 (16-29)20 (16-30).93Median duration of HS, y (IQR)14 (5-24)12 (4-20.5)20 (8.8-29.3)<.001Median No. of affected locations (IQR)3 (2-4)3 (2-4)3 (2-6)<.001Lesion location, n (%) Axillae326 (64.0)231 (61.1)95 (72.5).019 Groin334 (65.6)237 (62.7)97 (74.0).018 Breasts109 (21.4)75 (19.8)34 (26.0).142 Gluteus186 (36.5)114 (30.2)72 (55.0)<.001 Abdomen101 (19.8)68 (18.0)33 (25.2).075 Genitals167 (32.8)93 (24.6)74 (56.5)<.001Treatment interrupted, n (%)135 (26.5)106 (28.0)29 (22.1).19Adverse events, n (%)145 (28.5)116 (30.7)29 (22.1).062BMI, Body mass index; HS, hidradenitis suppurativa; IQR, interquartile range.∗ Hurley stage II: recurring boils in multiple areas with scarring and sinus tracts.† Hurley stage III: widespread boils with multiple interconnected tracts across the affected area, with no normal-appearing skin left between them. Open table in a new tab Table IIDemographic and disease characteristics related to treatment interruptionVariableTreatment interrupted, % (n/N)OR (95% CI)P valueORa (95% CI)P valueaFemale73.4% (174/237)1.0 (0.7-1.5).98——Male26.6% (63/237)Age, y ≤3020.3% (27/133)1—1— 31-3826.8% (34/127)1.4 (0.8-2.5).221.4 (0.8-2.5).26 39-4927.2% (34/125)1.5 (0.8-2.6).191.4 (0.8-2.5).27 ≥5032.3% (40/124)1.9 (1.1-3.3).0301.8 (1.0-3.1).048BMI ≥25 kg/m228.2% (97/344)1.4 (0.9-2.2).21——Smoking29.4% (106/360)1.5 (1.1-2.1).021.7 (1.0-2.7).033Age at onset, y ≤1625% (33/132)1——— 17-2028.1% (39/139)1.2 (0.7-2.0).57—— 21-2924.5% (27/110)1.0 (0.5-1.8).94—— ≥3027.9% (34/122)1.2 (0.7-2.0).60——Mean duration of HS ≤5 y23.4% (32/137)0.8 (0.5-1.3).34——Hurley stage II28% (106/378)1.4 (0.9-2.2).19——≤2 affected locations29.6% (67/226)1.3 (0.9-2.0).15——BMI, Body mass index; CI, confidence interval; OR, odds ratio; ORa, adjusted odds ratio; P valuea, adjusted P value. Open table in a new tab BMI, Body mass index; HS, hidradenitis suppurativa; IQR, interquartile range. BMI, Body mass index; CI, confidence interval; OR, odds ratio; ORa, adjusted odds ratio; P valuea, adjusted P value. In conclusion, to our knowledge, this is the largest reported series of patients treated with a combination of clindamycin plus rifampicin for HS. We observed higher rates of treatment interruption and prevalence of adverse effects than previously reported. Patients aged 50 years or older and smokers were more prone to interrupt their treatment. GI disturbances were the most frequent adverse effects in our population. Physicians may consider prescribing probiotics to these patients at higher risk of GI side effects.5Goldenberg J.Z. Yap C. Lytvyn L. et al.Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children.Cochrane Database Syst Rev. 2017; : CD006095Google Scholar Comment on "Interruption of oral clindamycin plus rifampicin therapy in patients with hidradenitis suppurativa: an observational study to assess prevalence and causes"Journal of the American Academy of DermatologyPreview Full-Text PDF
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