High-dose, high-frequency infliximab: A novel treatment paradigm for hidradenitis suppurativa - 06/02/20

Doi : 10.1016/j.jaad.2019.09.071

Mondana H. Ghias, BS ^a, Andrew D. Johnston, MS ^a, Allison J. Kutner, MD ^a, Robert G. Micheletti, MD ^b, H. Dean Hosgood, PhD ^c, Steven R. Cohen, MD, MPH ^a,^⁎
^a Division of Dermatology, Department of Internal Medicine, Albert Einstein College of Medicine, Bronx, New York
^b Departments of Dermatology and Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
^c Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York

^∗Reprint requests: Steven R. Cohen, MD, MPH, 3411 Wayne Ave, 2nd Floor, Ste D, Bronx, NY 10467.3411 Wayne Ave, 2nd Floor, Ste DBronxNY10467

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Abstract

Background

The permanent disfigurement associated with hidradenitis suppurativa (HS) necessitates early aggressive disease intervention. Although limited data support the use of infliximab (IFX) in HS, the efficacy of high-dose, high-frequency IFX has yet to be defined.

Objective

To evaluate the efficacy of IFX 7.5 to 10 mg/kg, with a maintenance frequency every 4 weeks.

Methods

Prospective analysis of 42 patients initiating IFX 7.5 mg/kg every 4 weeks (IFX 7.5) and 16 patients receiving dose escalation to IFX 10 mg/kg every 4 weeks (IFX 10) between March 1, 2018, and February 28, 2019. The primary outcome measure (clinical response) was the proportion of patients with Physician Global Assessment of clear, minimal, or mild (score of 0-2) HS with at least a 2-grade improvement from baseline scores.

Results

The proportion of patients achieving a clinical response after initiating IFX 7.5 was 20 of 42 (47.6%) at week 4 and 17 of 24 (70.8%) at week 12. For patients receiving dose escalation to IFX 10 because of incomplete initial response, 6 of 16 (37.5%) achieved clinical response at week 4 and 6 of 12 (50%) at week 12.

Conclusions

Initiation of IFX 7.5 every 4 weeks, with possible dose escalation to IFX 10, if needed, provides optimal mitigation of HS-related disease activity.

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Key words : acne inversa, anti-TNF, anti–TNF-α therapy, biologics, hidradenitis, hidradenitis suppurativa, high dose, high frequency, infliximab, TNF inhibitor

Abbreviations used : BMI, HS, IBD, IFX, IFX 5, IFX 7.5, IFX 10, MCID, NRS, PGA, SAE

Plan

Methods

Study design

Patient selection and data collection

Statistical analysis

Results

High-dose, high-frequency IFX-HS prospective cohort

IFX 7.5 every 4 weeks significantly reduces disease burden

Dose escalation to IFX 10 after inadequate control on IFX 7.5 improves outcomes

Discussion

Conclusion

	Funding sources: Mr Johnston was supported by the Albert Einstein College of Medicine Medical Scientist Training Program (NIH NIGMS T32 GM007288).
	Disclosure: Dr Cohen has served as principal investigator and on the advisory board for AbbVie, Inc, and on the advisory board for Verrica Pharmaceuticals. Ms Ghias, Mr Johnston, and Drs Kutner, Micheletti, and Hosgood have to conflicts of interest to declare.
	IRB approval status: Reviewed and approved by the Albert Einstein College of Medicine/Montefiore Medical Center IRB (2015-5906).
	Supplemental tables and figures available at 9mhhh2zjbb.2.