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The efficacy and tolerability of tetracyclines and clindamycin plus rifampicin for the treatment of hidradenitis suppurativa: Results of a prospective European cohort study - 08/07/21

Doi : 10.1016/j.jaad.2020.12.089 
Kelsey R. van Straalen, MD, PhD a, Thrasyvoulos Tzellos, MD, PhD b, Phillipe Guillem, MD, PhD c, d, e, Farida Benhadou, MD, PhD f, Carlos Cuenca-Barrales, MD g, h, Mathilde Daxhelet, MD f, Mathieu Daoud, MD f, Ourania Efthymiou, MD i, Evangelos J. Giamarellos-Bourboulis, MD, PhD j, Gregor B.E. Jemec, MD, DMSci k, Alexandros C. Katoulis, MD i, Anke Koenig, MD, PhD l, Elizabeth Lazaridou, MD, PhD m, Angelo V. Marzano, MD n, o, Łucas Matusiak, MD, PhD p, Alejandro Molina-Leyva, MD, PhD g, h, Chiara Moltrasio, MRes n, q, Andreas Pinter, MD, PhD l, Concetta Potenza, MD r, Jorge Romaní, MD, PhD s, Ditte M. Saunte, MD, PhD k, Nevena Skroza, MD r, Dimitra Stergianou, MD j, Jacek Szepietowski, MD, PhD, FRCP p, Anastasia Trigoni, MD, PhD m, Eva Vilarrasa, MD t, Hessel H. van der Zee, MD, PhD a,
a Erasmus MC, University Medical Center Rotterdam, Department of Dermatology, Rotterdam, the Netherlands 
b Department of Dermatology, Nordland Hospital Trust, Bodø, Norway 
c Department of Surgery, Clinique du Val d’Ouest, Lyon, France 
d ResoVerneuil, Paris, France 
e Groupe de Recherche en Proctologie de la Société Nationale Française de ColoProctologie, Paris, France 
f Department of Dermatology, Université Libre de Bruxelles, Erasme Hospital, Brussels, Belgium 
g Department of Dermatology, Hospital Universitario Virgen de las Nieves, Granada, Spain 
h TECe19-Clinical and Translational Dermatology Investigation Group Instituto de Investigación Biosanitaria, Granada, Spain 
i Second Department of Dermatology and Venereology, National and Kapodistrian University of Athens, Medical School, “Attikon” General University Hospital, Athens, Greece 
j Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece 
k Department of Dermatology, Zealand University Hospital, Roskilde and Health Sciences Faculty, University of Copenhagen, Denmark 
l Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt am Main, Germany 
m Second Department of Dermatology and Venereology, Aristotle University of Thessaloniki, General Hospital Papageorgiou, Thessaloniki, Greece 
n Dermatology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy 
o Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy 
p Department of Dermatology, Venereology and Allergology, Medical University, Wroclaw, Poland 
q Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy 
r Dermatology Unit ‘Daniele Innocenzi,’ Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino-Latina, Italy 
s Department of Dermatology, Corporació Sanitaria Parc Taulí, Sabadell, Spain 
t Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain 

Correspondence to: Hessel H. van der Zee, MD, PhD, Department of Dermatology, Erasmus University Medical Center, dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands.Department of DermatologyErasmus University Medical Centerdr. Molewaterplein 40Rotterdam3015 GDthe Netherlands

Abstract

Background

Tetracyclines and clindamycin plus rifampicin combination therapy are both considered first-line therapy in current hidradenitis suppurativa guidelines. However, evidence for their efficacy is drawn from small studies, often without validated outcomes.

Objective

To assess the 12-week efficacy of oral tetracyclines and a combination of clindamycin and rifampicin.

Methods

A prospective, international cohort study performed between October 2018 and August 2019.

Results

In total, 63.6% of the included 283 patients received oral tetracyclines, and 36.4% were treated with clindamycin and rifampicin. Both groups showed a significant decrease in International Hidradenitis Suppurativa Severity Score System from baseline (both P < .001). The Hidradenitis Suppurativa Clinical Response (HiSCR) was achieved in 40.1% and 48.2% of patients, respectively (P = .26). Patient characteristics or disease severity were not associated with the attainment of HiSCR or the minimal clinically important differences for the Dermatology Life Quality Index and pain.

Limitations

Cohort study. Respectively, 23.9% and 19.4% of patients had to be excluded from the HiSCR analysis for the tetracycline and combination therapy group because of a low abscess and nodule count at baseline.

Conclusion

This study shows significant efficacy of both tetracycline treatment and clindamycin and rifampicin combination therapy after 12 weeks in patients with hidradenitis suppurativa. No significant differences in efficacy were observed between the 2 treatments, regardless of disease severity.

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Key words : acne inversa, antibiotics, clindamycin, doxycycline, efficacy, guideline, minocycline, outcome, rifampicin, tetracycline, therapy, treatment

Abbreviations used : BMI, CI, DLQI, HiSCR, HS, IHS4, MCID, NRS, OR, PROM


Plan


 Drs van Straalen and Tzellos contributed equally to this article.
 Funding sources: None.
 IRB approval status: The study was performed within daily practice and in accordance with current guidelines; therefore, it was deemed exempt from IRB review.
 Reprints not available from the authors.


© 2021  American Academy of Dermatology, Inc.. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 85 - N° 2

P. 369-378 - août 2021 Retour au numéro
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