A prospective clinical trial of open-label etanercept for the treatment of hidradenitis suppurativa

Robert A. Lee, Erica Dommasch, James Treat, Joslyn Sciacca-Kirby, Samuel Chachkin, Jennifer Williams, Daniel B. Shin, James J. Leyden, Carmela Vittorio, Joel M. Gelfand

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75 Scopus citations

Abstract

Background: Medical therapies for hidradenitis suppurativa (HS) are often ineffective. Tumor necrosis factor-α inhibitors may be a potential treatment for patients with moderate to severe HS. Objectives: We sought to evaluate the safety and efficacy of etanercept for patients with severe HS. Methods: We conducted a phase II clinical trial of etanercept (50 mg/wk subcutaneously) in patients with moderate to severe HS. Efficacy was measured using a Physician Global Assessment and several secondary physician- and patient-reported outcome measures. Responders were classified as those achieving at least a 50% reduction on the Physician Global Assessment score at week 12 compared with baseline. Results: Only 3 of the 15 patients who entered the study were classified as responders (response rate of 20%; 95% confidence interval: 4.3-48.1) based on the intention-to-treat analysis. Dermatology Life Quality Index scores improved slightly from a median of 19 to 15 (P = .02). Comparison of baseline with week-12 Physician Global Assessment scores, and secondary outcome measures of lesion counts and patient pain scores, failed to show statistically significant improvement. Etanercept was generally well tolerated; however, two patients discontinued the study as a result of skin infections at the site of hidradenitis lesions requiring oral antibiotics. Limitations: Lack of a control group and a small number of participants are limitations. Conclusions: Our study demonstrated minimal evidence of clinically significant efficacy of etanercept (50 mg/wk subcutaneously) in the treatment of hidradenitis. Future studies using higher doses of etanercept are indicated; however, patients need to be carefully monitored for infection and other adverse events. Randomized, controlled trials will be necessary to demonstrate the risk-to-benefit ratio of tumor necrosis factor-α inhibitors in the treatment of hidradenitis.

Original languageEnglish (US)
Pages (from-to)565-573
Number of pages9
JournalJournal of the American Academy of Dermatology
Volume60
Issue number4
DOIs
StatePublished - Apr 2009

All Science Journal Classification (ASJC) codes

  • Dermatology

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    Lee, R. A., Dommasch, E., Treat, J., Sciacca-Kirby, J., Chachkin, S., Williams, J., Shin, D. B., Leyden, J. J., Vittorio, C., & Gelfand, J. M. (2009). A prospective clinical trial of open-label etanercept for the treatment of hidradenitis suppurativa. Journal of the American Academy of Dermatology, 60(4), 565-573. https://doi.org/10.1016/j.jaad.2008.11.898