Window of Opportunity and Predictors of Sustained Remission in Patients with Hidradenitis Suppurativa Treated with Adalimumab

INTRODUCTIONHidradenitis suppurativa (HS) is a chronic inflammatory skin disease. Predicting responses of "prolonged disease-free remission" to biological therapy is essential for identifying a "window of opportunity" for disease modification.

METHODSA retrospective multicenter cohort study (2015-2023) of 540 patients with HS treated with adalimumab (ADA) was performed. A super-response to ADA (ADA-SR; ADA super-responders) was defined as sustained complete remission (absence of nodules, abscesses, and inflamed or draining tunnels) for ≥ 12 months leading to drug discontinuation. Predictors were analyzed using multivariable Cox regression. Clinically interpretable thresholds were derived post hoc via maximally selected log-rank statistics.

RESULTSOf the 540 patients, 19 (3.5%) were identified as ADA-SR. Median [interquartile range (IQR)] overall ADA survival was 56.2 (51.15-80.25) months, while the median time to ADA discontinuation in ADA-SR was 18.6 (IQR 23.3-41) months. After discontinuation, six of the 19 ADA-SR patients (31.6%) experienced relapse during follow-up; only one required the reintroduction of biologic therapy. ADA-SR patients demonstrated distinct clinical, demographic, and therapeutic profiles. Independent predictors of sustained remission included lower body mass index (BMI < 29 kg/m2), shorter time from disease onset to biologic initiation (within 3 years), and lower baseline tunnel burden (< 3 tunnels).

CONCLUSIONLower BMI, early biologic intervention, and a limited baseline burden of tunnels are key predictors for achieving sustained remission off-drug, supporting a limited window of opportunity in HS. Graphical abstract available for this article.

Abstract from PubMed