The road to biologics in patients with hidradenitis suppurativa: a nationwide drug utilization study

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Background: Prolonged systemic antibiotic treatment is often a part of management of hidradenitis suppurativa (HS). Although biologic therapies are now available, the patient’s treatment journey leading to biologic therapy is unclear. Objectives: To examine treatment patterns and duration of systemic treatment use in patients with HS preceding biologic therapy. Methods: We identified all patients with HS receiving treatment with biologics in the Danish National Patient Registry from 2010 to 2018 and extracted their entire prescription history of specific systemic treatments from the Danish National Prescription Registry since its inception in 1995. The patients’ treatment journeys are graphically displayed through Sankey diagrams and box plots generated to show temporal distributions. Descriptive patient characteristics were presented as frequencies with percentages for categorical variables and as means with SDs or medians with interquartile ranges (IQRs) for continuous variables. Results: A total of 225 patients with HS were included. Patients had most frequently been treated with penicillin (n = 214; 95·1%), dicloxacillin (n = 194; 86·2%), tetracycline (n = 145; 64·4%) and rifampicin/clindamycin (n = 111; 49·3%), as well as the retinoids isotretinoin and acitretin, and dapsone. Prior to biologic therapy, patients received a mean of 4·0 (SD 1·3) different systemic therapies, across a mean of 16·9 (SD 11·3) different treatment series. The mean time from first systemic therapy until biologic therapy was initiated was 15·3 (SD 5·1) years [8·2 (SD 5·9) years when excluding penicillin and dicloxacillin]. Conclusions: Patients with HS who receive biologic therapy have long preceding treatment histories with multiple drug classes and treatment series, many of which are supported by relatively weak evidence in HS. Delay in the initiation of biologic therapy may represent a missed opportunity to prevent disease progression. What is already known about this topic? The treatment journey leading to biologic therapy in patients with HS has not previously been investigated. What does this study add? Our data from 225 patients with HS illustrate that patients who receive biologic therapy have long preceding treatment histories with multiple drug classes and treatment series, many of which are supported by relatively weak evidence in HS.

TidsskriftBritish Journal of Dermatology
Udgave nummer4
Sider (fra-til)523-530
Antal sider8
StatusUdgivet - 2022

Bibliografisk note

Funding Information:
No funding was received for this study. With no relation to the work in the present manuscript, J.P.T. is supported by a grant from the Lundbeck Foundation.

Funding Information:
H.C.R. has received research funding from the Kgl Hofbundtmager Aage Bang Foundation and honoraria as speaker from LEO Pharma. J.‐T.M has served as advisor and/or received speaking fees and/or participated in clinical trials sponsored by AbbVie, Almirall, Amgen, BMS, Celgene, Eli Lilly, LEO Pharma, Janssen‐Cilag, MSD, Novartis, Pfizer, Pierre Fabre, Roche, Sanofi and UCB. J.W.F. has conducted advisory work for Janssen, Boehringer Ingelheim, Pfizer, Kyowa Kirin, LEO Pharma, Regeneron, Chemocentryx, AbbVie and UCB, participated in trials for Pfizer, UCB, Boehringer Ingelheim, Eli Lilly, CSL and Janssen, and received research support from Ortho Dermatologics and Sun Pharma. J.R.I. is a consultant and/or advisory board member for Novartis, UCB, ChemoCentryx, Boehringer Ingelheim, Viela Bio and Kymera Therapeutics and receives, as Editor‐in‐Chief, an editorial stipend from the and an author honorarium from UpToDate. He is co‐copyright holder of the Hidradenitis Suppurativa Quality Of Life scale and Investigator and Patient Global Assessment instruments for hidradenitis suppurativa. J.J.W. is or has been an investigator, consultant or speaker for AbbVie, Almirall, Amgen, Arcutis, Aristea Therapeutics, Bausch Health (Ortho Dermatologics), Boehringer Ingelheim, Bristol‐Myers Squibb, Dermavant, Dr. Reddy's Laboratories, Eli Lilly, Galderma, Janssen, LEO Pharma, Mindera, Novartis, Regeneron, Sanofi‐Genzyme, Solius, Sun Pharmaceutical, UCB and Zerigo Health. J.P.T. is an advisor for AbbVie, Almirall, Arena Pharmaceuticals, Coloplast, OM Pharma, Aslan Pharmaceuticals, Union Therapeutics, Eli Lilly & Co, LEO Pharma, Pfizer, Regeneron and Sanofi‐Genzyme, a speaker for AbbVie, Almirall, Eli Lilly & Co, LEO Pharma, Pfizer, Regeneron and Sanofi‐Genzyme and received research grants from Pfizer, Regeneron and Sanofi‐Genzyme. S.F.T. has been a speaker and/or served on advisory boards for AbbVie, Almirall, Eli Lilly, Janssen, LEO Pharma, Novartis, Pfizer, Sanofi and UCB and has received research support from AbbVie, Janssen, LEO Pharma, Novartis, Sanofi and UCB. A.E. has received research funding from Pfizer, Eli Lilly, Novartis, Bristol‐Myers Squibb, AbbVie, Janssen Pharmaceuticals, the Danish National Psoriasis Foundation, the Simon Spies Foundation and the Kgl Hofbundtmager Aage Bang Foundation, and honoraria as consultant and/or speaker from AbbVie, Almirall, LEO Pharma, Zuellig Pharma, Galápagos NV, Sun Pharmaceuticals, Samsung Bioepis, Pfizer, Eli Lilly, Novartis, Galderma, Dermavant, UCB, Mylan, Bristol‐Myers Squibb and Janssen Pharmaceuticals. The other authors declare they have no conflicts of interest. British Journal of Dermatology

Publisher Copyright:
© 2022 The Authors. British Journal of Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists.

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