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Adalimumab for the Treatment of Hidradenitis Suppurativa FREE

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The full report is titled “Adalimumab for the Treatment of Moderate to Severe Hidradenitis Suppurativa. A Parallel Randomized Trial.” It is in the 18 December 2012 issue of Annals of Internal Medicine (volume 157, pages 846-855). The authors are A.B. Kimball, F. Kerdel, D. Adams, U. Mrowietz, J.M. Gelfand, R. Gniadecki, E.P. Prens, J. Schlessinger, C.C. Zouboulis, H.H. van der Zee, M. Rosenfeld, P. Mulani, Y. Gu, S. Paulson, M. Okun, and G.B.E. Jemec.

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Ann Intern Med. 2012;157(12):I-50. doi:10.7326/0003-4819-157-12-201212180-00001
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What is the problem and what is known about it so far?

Hidradenitis suppurativa (HS) is a chronic skin disease in which painful, draining, and foul-smelling areas of swelling occur in the armpits, in the groin, under the breasts, and sometimes in other areas. The condition waxes and wanes. Usual treatments include antibiotics and surgical opening of the swellings, but these approaches are often not effective.

Why did the researchers do this particular study?

Several patient reports and small studies have suggested that a class of drugs called tumor necrosis factor antagonists, which act by suppressing the immune system, may alleviate HS. Adalimumab is a drug in this class.

Who was studied?

Patients with moderate to severe HS who were not adequately responding to antibiotics or who could not tolerate antibiotics because of adverse effects.

How was the study done?

154 patients were divided into 3 groups that received, by randomized assignment, adalimumab every week, adalimumab every other week, or a placebo. Patients and doctors did not know which drug each patient received. After 16 weeks, all patients received adalimumab every other week, but if HS worsened, treatment reverted to every week. The total time in which patients were treated was up to 1 year.

What did the researchers find?

Patients with HS who initially received adalimumab every week had improved symptoms and measures of quality of life compared with patients who received placebo. When adalimumab treatment frequency was reduced from every week to every other week, some patients had worsening HS. Serious adverse effects were not common and had a similar pattern in all groups, but the total number of patients studied was relatively small. The trial was not large enough to accurately measure for serious infections and types of cancer that have been reported with adalimumab in other diseases. Longer studies that include more patients are needed to better understand the benefits and risks of treating HS with adalimumab.





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