Secukinumab Potentially Effective, Safe in Patients With HS Not Responding to Adalimumab

Researchers of a new study have found that targeting interleukin-17 (IL-17) may be an effective and safe for approach for treating hidradenitis suppurativa (HS) not adequately controlled by current biologic treatment.

The retrospective study, published in Dermatology and Therapy, showed that anti–IL-17 drug secukinumab yielded favorable results in a small group of patients with severe HS.

“Adalimumab is currently the only biologic drug approved for the treatment of HS. If the disease is not controlled with this drug, there is no other approved therapeutic alternative,” explained the researchers. “In the context of severe refractory disease, off-label uses of biological drugs with potential benefit in HS, such as secukinumab, guselkumab, brodalumab, and ustekinumab, among others, have been used.”

The mean number of biologics used prior to secukinumab was 1.3, with all patients being treated with at least 1 other drug prior to the anti–IL-17 treatment. Almost all (97.9%) patients had prior failure on adalimumab, and the remaining 2.1% had a contraindication for the treatment.

After 16 weeks, 48.9% of the 47 patients achieved a response based on Hidradenitis Suppurativa Clinical Response (HiSCR) criteria. Mean International HS Severity Scoring System result decreased from 21.1 to 12.7, with a 55% reduction seen in 40.4% of patients.

Multivariate analysis showed that lower therapeutic burden could potentially predict response to secukinumab. Receiving 5 or fewer treatment was associated with a response rate of 70% compared with 33% among patients who received more than 5 interventions. The analysis also showed that patients who were female and had a lower body mass index (BMI) and a lower therapeutic burden were more likely to achieve HiSCR.

While 67% of women achieved HiSCR at week 16, just 30.4% of men achieved the marker.

“On the other hand, there are data showing that a higher BMI is potentially associated with a poorer response to biologic therapy in immune-mediated diseases. It has been hypothesized that the usual dose of the drug could be insufficient in obese patients, since obesity implies a greater volume of distribution of the drug and therefore a lower drug concentration,” wrote the researchers. “Also, as the biologic drug is administered subcutaneously, a greater amount of subcutaneous adipose tissue could limit its absorption. These hypotheses could be extrapolated to secukinumab treatment in HS, which could explain why a higher BMI is associated with a lower effectiveness of the drug.”

Treatment was given at 300 mg subcutaneously in weeks 0 through 4. There were 12 patients who then received 300 mg every 2 weeks while 35 received the same dose every 4 weeks. There were no statistically significant differences in efficacy based on dosing schedule.

Treatment was discontinued in 19% of patients after their week 16 visit; 6 of these 9 patients discontinued due to lack of treatment response, 1 patient discontinued due to worsening HS, and 2 patients discontinued due to adverse effects. Adverse reactions occurred in just under 7% (n = 3) of patients. Reactions included oral candidiasis, worsening psoriasis, and joint pain and inflammation.

Reference

Fernandez-Crehuet P, Haselgruber S, Padial-Gomez A, et al. Short-term effectiveness, safety, and potential predictors of response of secukinumab in patients with severe hidradenitis suppurativa refractory to biologic therapy: a multicenter observational retrospective study. Dermatol Ther. Published inline March 9, 2023. doi:10.1007/s13555-023-00906-2