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Does Delaying Adalimumab Affect Treatment Response?

Findings from a recent study suggest there is a “window of opportunity” for initiating adalimumab (Humira) among patients with hidradenitis suppurativa (HS). According to the study, delayed treatment was associated with a lack of response.

While adalimumab is the only biologic approved for HS, no predictors of response have been identified thus far, the researchers said. They investigated clinical parameters for predicting response to adalimumab among 389 participants with HS treated with the biologic at 21 centers in Italy.

Hidradenitis Suppurativa Clinical Response (HiSCR) was used to measure treatment response, and dermatology Quality of Life index (DLQI) and the Visual Analogue Scale (VAS) for pain were used to evaluate quality of life. In addition, the researchers assessed sex, ages at onset/diagnosis/baseline, body mass index, smoking, phenotypes, previous treatments, concomitant antibiotic use, and therapeutic delay, defined as the time from HS onset to adalimumab initiation.
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Therapeutic delay correlated with a lack of response to adalimumab at week 16 (odds ratio [OR] 1.92 for therapeutic delay for less than 10 years; 95% CI, 1.28-2.89), the researchers said. They also found HiSCR was achieved by 43.7% and 53.9% of participants at weeks 16 and 52, respectively. Compared with baseline, the researchers observed significant reductions in both DLQI and VAS pain scores at week 16 and week 52.

In addition, previous immunosuppressants inversely correlated with HiSCR at week 52 (OR 1.74; 95% CI, 1.04-2.91), the researchers wrote.

“Inverse correlation between therapeutic delay and clinical response was found, supporting early adalimumab use and providing evidence for a ‘window of opportunity’ in HS,” the researchers concluded. “Immunosuppressants could negatively influence response to adalimumab inducing a switch to non-TNFα -driven pathways.”


Marzano AV, Genovese G, Casazza G, et al. Evidence for a "window of opportunity" in hidradenitis suppurativa treated with adalimumab: a retrospective, real-life multicenter cohort study [published online March 2, 2020]. Br J Dermatol. doi:10.1111/bjd.18983

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