March 31, 2022
Hidradenitis Suppurativa — The Future of Patient Management
Spherix’s Dermatology Franchise Head, Gianna Melendez, discusses insights she’s uncovered from her work in the hidradenitis suppurativa (HS) market and looks to the future of disease management.
What is hidradenitis suppurativa?
Hidradenitis suppurativa (HS), or acne inversa, is a chronic inflammatory condition that causes painful and recurrent abscesses. Eventually, the illness progresses to the sinus tracts and causes scarring in intertriginous locations of the body. Needless to say, the disease greatly impacts the lives of HS patients.
What strikes me the most about HS is the fact that patients are not achieving much relief despite nearly all patients being on concomitant treatments – sometimes 3,4, or even 5 different agents! I believe the lack of treatment success boils down to the fact that the causes and pathways of HS are still unknown. In my opinion, much more research needs to be done in order to identify the best treatment options for those suffering from this disease, but that’s for the scientists to solve! Let’s focus on what we know today.
It is estimated that 1-4% of the worldwide population suffers from hidradenitis suppurativa. HS often develops when hair follicles become blocked. The disease is potentially linked to hormones, genetics, and/or compromised immune function. HS disproportionately affects females, is most common in patients aged 18-45, and usually affects those that are obese, smokers, and have a family history of HS.
Symptoms include painful nodules of the hair follicles, abscesses, tunneling, drainage, and scarring which usually occur in skin folds, armpits, groin, breasts, and buttocks. These symptoms are often classified as moderate to severe, with available treatments having little to no impact.
Standard of care includes topical and systemic antibiotics, corticosteroids, hormonal therapies, immunomodulators, and surgical modalities. Currently, Humira (adalimumab) is the only proven and indicated biological treatment for patients with moderate to severe disease.
Why is HS hard to treat?
The main issue with hidradenitis suppurativa patient care occurs the very first time they arrive at a doctor’s office. When patients first present with HS symptoms, they are referred to multiple physicians and are often originally misdiagnosed. In many cases, patients have been dealing with painful symptoms for many years with no relief in sight. After finally arriving at a dermatologist’s office, patients are frustrated and lack trust in any doctor offering them treatment options. This patient mismanagement often results in a hesitancy to initiate systemic therapies.
Through talking with dermatologists about this hesitancy, we have discovered that the root of the issue lies in communication between doctors and patients. In other words, patients struggle to understand HS and how it can be treated, and doctors may struggle to communicate accurate treatment options to patients. Overall, confusion on HS, in general, is often to blame for this lack of communication.
Dermatologists have been taking action to remedy this lack of communication by prioritizing education when taking on new patients suffering from HS. With new biologics potentially entering the market soon, education and awareness will be huge hurdles for drug manufacturers. As shown in the research I’ve collected with Spherix, these are already the top barriers to use for AbbVie’s Humira.
How to solve this communication issue is twofold: first, patients must be educated, which will increase their confidence and build trust. Second, dermatologists need to be equipped with the tools to have these important discussions with their patients.
What Does The Future of Care Look Like?
Now, let’s talk more about current treatment options. As I previously stated, nearly all patients are on multiple therapies. For those with moderate or severe disease, they are likely to be prescribed antibacterial washes, topical and systemic antibiotics, and intralesional steroid injections. Humira is predominantly used in more severe patients. However, AbbVie’s brand is falling short in HS. Only about 40% of Humira patients are well managed (vs. about 70% of patients on biologics in psoriasis). The brand’s leading barriers include patient reluctance, insurance issues, and efficacy concerns.
In our discussions with dermatologists, we uncovered that Humira works well for patients that present with moderate HS, prior to developing tunneling and scarring. Conversely, Humira is not ideal for patients that have severe HS and already present with irreversible symptoms. We know Humira is currently reserved for severe patients, likely a result of patient reluctance which in turn results in the agent being used as a last resort – bringing us back to the core issue. If we can dispel patients’ misconceptions, rebuild medical trust, and equip dermatologists with the appropriate tools to have these discussions with patients, biologics can potentially be moved up the treatment algorithm.
Looking toward future management, the pipeline has several novel and legacy products used in the dermatology field. Products that are closest to market entry include Novartis’s Cosentyx (expected to submit to the FDA this year), UCB’s bimekizumab, and InflaRx’s vilobelimab. Other products Spherix inquires about in our research include:
According to our data, nearly 60% of dermatologists believe the alternative mechanisms of action (IL-17s, IL-1s, etc.) will be more efficacious for the treatment of HS than TNF inhibitors (aka. Humira), which is an increase compared to what dermatologists reported in 2020. If one agent were to get the green light from the FDA, Cosentyx is the favorite, followed distantly by bimekizumab.
Perhaps as expected, when you pin Cosentyx and bimekizumab against each other, familiarity is stronger for Cosentyx, and substantially more dermatologists indicate they are likely to prescribe it within the first three months once commercially available.
As we gain more information about HS, treatments will start to improve, physicians will know how to successfully treat the disease, and trust will be rebuilt amongst patients. I choose to be optimistic for these patients and look forward to the day that I can report patients are experiencing minimal symptoms.
Spherix is proud to provide research on rare indications like HS and will continue to track the market as part of our Market Dynamix™ series (third annual wave available November 2022). We are also excited to now offer insight into how HS is managed across the pond in the EU5 (available June 2022).
About Market Dynamix™
Market Dynamix™ is an independent service providing analysis of markets anticipated to experience a paradigm shift within the next three to five years. Insights highlight market size, current treatment approaches, unmet needs, and expert opinions on the likely disruption introduced by pipeline agents.
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