HS Treatment Goals: Better Quality of Life, Not Just Control

For part 3 of our discussion with Chris Sayed, MD, we tackle several important topics in the hidradenitis suppurative (HS) and inflammatory disease space: patient quality of life, medication and treatment goals, and the possibility of a cure.

Sayed is a dermatologist and professor at the University of North Carolina at Chapel Hill Department of Dermatology, as well as an investigator for the with the BE HEARD I and II trials, data from which supported UCB Pharma’s successful application of bimekizumab (Bimzelx) for HS for FDA approval on November 20.

For parts 1 and 2 of our interview with Sayed, please click below:

• Part 1: BE HEARD Trials Highlight Efficacy of Bimekizumab in Hidradenitis Suppurativa
• Part 2: Subcutaneous HS Therapy: Efficacy and Safety Insights

This transcript has been lightly edited for clarity.

Transcript

How do these inflammatory conditions affect patient quality of life?

Different inflammatory conditions have a lot of connections when it comes to how they affect quality of life. We know that whether patients have psoriasis, where their skin is going to be inflamed and symptomatic and they're going to be worried about people seeing their skin and asking them questions, or people who have inflammatory joint disease, where they can't be physically active when they want to be or do the job that they need to do to be able to sort of keep occupations, that's got a huge impact on how they live their life.

HS is no different than that.It impacts all of those things. And often these conditions run together. We know that there's higher rates of psoriasis in HS patients compared to people who don't have HS. The same is true for inflammatory joint disease. It's like if the body is kind of keyed up to do any one of these inflammatory responses, it's more likely to make the others. Often I'll treat a patient with HS with a systemic drug, and they'll come back and say, “I didn't realize how bad my joints hurt until I started this medication, and now I feel better and I can be more active again.”

I think, and I tell patients all the time with any of these conditions, that the whole point of medication is to help you live a better life. That means that you can be more active, you can sort of be more engaged with your family, with your work, with your leisure time—and you have less concern about your health holding you back from the thing that you want to do to live your life normally.

That's the goal. And if we don't achieve that, it means we're going to be changing things over time to make sure we do.

Is an HS cure possible, and what barriers must be overcome to achieve this?

A cure for HS is something that is hard to really completely define at this point.One of the biggest problems with HS is that it leaves damage behind. It's not like eczema or psoriasis where you could give somebody a medicine and you completely erase it and everything goes back to normal. There's been this destruction left behind, and so it's going to be hard to erase every mark left behind.

My hope is that one day we have medication so effective that people can feel like, “I have no impact on my quality of life.” We know that we need to intervene early and not let patients collect that damage that means that it becomes less reversible over time. Like most other chronic inflammatory conditions, whether it's rheumatoid arthritis or Crohn's disease, it's a challenge.

Once the body has been sort of programmed or sort of has this immune memory to continue this response over time, we're often thinking about controlling it more than a one-time cure. And so for most patients, it means over a period of time, whether it's years, sometimes decades, we're probably going to be trying just to control as tightly as we can and prevent it from advancing and creating a bigger impact on quality of life. And hopefully the medicines get better and better at doing that.

But it's going to be hard to find that on/off switch until we make major advances understanding what are the genetics that underlie the disease and how do we correct genetic changes in a safe way or how we find those particular switches that we can reprogram in the long run rather than just temporarily altering things with a medication that leaves the system after a week or two.

The exception to that is that some patients with HS may have disease that has become relatively stable over time, it's just 1 or 2 stubborn areas. And there's a major role for surgery in HS.Sometimes if patients have relative disease stability, if you remove the 1 or 2 areas that are causing problems over and over again, they can maintain what feels like a long-term remission or a cure without needing medication in the long run. It's just really hard to guarantee that. There's no patient that I could do surgery on, and we get them completely clear and I could tell them, “Don't ever worry about HS again; it will never come back.”

It's like trying to predict anything in the future; it’s hard to know exactly what's going to happen with that particular patient. I think we'll always, at minimum, have to be watchful to make sure that patients maintain response, but I'd love for a day when a cure comes and I can give somebody the 1-time pill, the 1-time injection, and then I tell them, “Go live your life and be happy now.”