Hidradenitis suppurativa: Discontinuation of adalimumab prior to surgery is not necessary

Hidradenitis suppurativa (Syn. Acneinversa) is one of the most troublesome and complicated skin diseases. The anti-inflammatory drug adalimumab can improve symptoms; however, patients also often have to undergo surgery. Until now, it was unclear whether adalimumab had to be discontinued prior to the procedure. A four-year worldwide multicentre study coordinated by Professor Falk Bechara from the Department of Dermatosurgery at the Bochum University Clinic for Dermatology (Director: Professor Eggert Stockfleth) came to the conclusion that discontinuation is not necessary. "This is a milestone for patients with moderate and severe hidradenitis suppurativa, who have to undergo surgery," says Falk Bechara. The results were published in the journal JAMA Surgery from 18 August 2021.

Not-curable yet, but more efficiently treated

Hidradenitis suppurativa is a chronic inflammatory disease caused by an occlusion of hair follicles. It often occurs under the arms, in the groin and in the genital area with severe embarassement for the patients. In advanced stages, the disease is extremely painful and also causes huge mental distress and a reduced quality of life. It is not yet curable, but the symptoms can be considerably improved by therapy options that have advanced considerably in recent years. The dermatosurgery department in Bochum, headed by Falk Bechara, is one of the leading international centres, treating 1,000 patients per year. The study, which involved 45 centres in 20 countries, was coordinated here.

The study focused on adalimumab, an immunomodulating, anti-inflammatory standard drug that has been used successfully for years - not only for hidradenitis suppurativa. Indication areas include severe psoriasis, but also rheumatic diseases and chronic inflammatory bowel diseases such as ulcerative colitis or Crohn's disease. The efficacy and safety of adalimumab has been evaluated in multiple trials in the past. Until now, however, it was unclear whether it could be combined and continued during surgical interventions, which are often necessary for patients with hidradenitis suppurativa. No data on this was available until now. The study included 200 patients, who received either the drug or a placebo.

Results to be evaluated for other diseases

The study shows that adalimumab doesn't need to be discontinued even when hidradenitis suppurativa surgery is performed. It is effective and safe both before and after surgery." Further studies are needed to determine to what extent these positive results of the study can be transferred to other diseases that also require surgery, as Bechara points out: "The outlook is certainly quite promising."

Falk Bechara, lead author of the study

Source:
Journal reference:

Bechara, F.G., et al. (2021) Efficacy and Safety of Adalimumab in Conjunction With Surgery in Moderate to Severe Hidradenitis Suppurativa. JAMA. doi.org/10.1001/jamasurg.2021.3655.

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