September 28, 2021
Unmet Need for New Treatment Options and Barriers to Adalimumab Use in Hidradenitis Suppurativa
Author: Gianna Melendez
Hidradenitis suppurativa (HS), or acne inversa, is a chronic inflammatory condition that presents as painful and recurrent abscesses that progress to sinus tracts and scarring in the intertriginous locations of the body, causing low quality of life in most patients. HS often develops when hair follicles become blocked and is potentially linked to hormones, genetics, and/or compromised immune function. Standard of care includes topical and systemic antibiotics, corticosteroids, hormonal therapies, immunomodulators, and surgical modalities. Currently, adalimumab is the only proven and indicated biological treatment for patients with moderate to severe disease. This research sought to understand the current treatment landscape and patient outcomes.
MATERIAL AND METHODS:
An independent market analytics firm collaborated with US dermatologists (n=101) from October 15 to 27, 2020 to gain insight on the current HS market. Data collected included patient symptomology, treatments, unmet needs, and attitudinal responses. Qualitative interviews were also conducted (n=11).
Regardless of severity, HS patients typically begin treatment with concomitant topical therapies. Only a minority of patients are successfully managed with topicals alone, and the majority require the addition of systemic antibiotics. Intralesional steroid injections are also prescribed at this point for patients with large cystic lesions. Adalimumab is reserved for moderate and severe HS patients who do not adequately respond to systemic antibiotics and topicals. As a last resort, surgery will be used for drainage. Overall, dermatologists indicate less than one-fifth of their HS patients are obtaining an optimal response to treatment, with 91% of patients still experiencing flares. As such, 67% and 90% of dermatologists report a high unmet need for new treatment options for moderate and severe HS, respectfully.
A result of being the only biologic approved for moderate-to-severe HS patients, 96% of dermatologists prescribe adalimumab to patients 12 and up. Dermatologists prescribe the biologic to 20% and 23% of moderate and 39% and 44% of severe adolescents and adults, respectfully. Of which, 39% of adalimumab patients are well managed and show good response to treatment; however, 61% of patients are not well maintained. Patient reluctance is adalimumab’s greatest barrier to use, a result of long-term injections and immunosuppression. Other top barriers to use include insurance coverage and efficacy concerns.
For moderate-to-severe HS patients to experience some relief, a treatment regimen of topical therapies, antibiotics, and potentially adalimumab are concomitantly prescribed, yet few patients are adequately controlled. Despite being the only proven and indicated biologic for moderate-to-severe HS, 61% of adalimumab patients are not well managed. Thus, current treatments leave dermatologists with few adequate options to treat moderate-to-severe HS.
GM: Spherix Global Insights, Exton, PA, USA