Editor's Note: In this interview, Hadar Lev-Tov, MD, MAS discusses the 2 approved medications for Hidradenitis suppurativa. At WoundCon Spring 2024, he presented, Hidradenitis Suppurativa and Wounds: Exploring the Unexplored.

Transcript

Hi everyone, my name is Hadar Lev-Tov, MD, I'm an associate professor of dermatology. I work at the University of Miami in the department of dermatology and cutaneous surgery. I'm also the president-elect of the HS Foundation, which is the largest non-profit that is advocating for a disease called Hidradenitis suppurativa, or HS for short.

Could you discuss the 2 approved medications for Hidradenitis suppurative?

So, yeah, that's a good question about biologics and HS. Biologics are a class of medications in which you take an antibody and really convert it chemically to target a specific target in the body. Now, in HS, we have 2 medications that are approved, just 2. And those medications are in the biologics category. These 2 are called adalimumab, which targets tumor necrosis factor, and then we have secukinumab that has been recently approved, and that targets to interleukin (IL)-17.

Now, just conceptually, it's important to understand that when we don't know what causes a disease, it is hard to target it to its source, right? And so with these medications, medications do, they go after the inflammatory response that is associated with HS. And so it helps to explain the results of these studies. Now, these have been studied extensively in large phase 3 studies, one program even about 1,000 people.

So really large studies, long-term, last of the year, in the case of secukinumab, and there's evidence also in adalimumab going up to a year and even further up to 3 years. And so we have good evidence that they help, but they're not a panacea. They don't cure the disease. And I think it's important to understand. A few other things to note.

In the studies, about half the patients saw a response and you would say to yourself, wait a minute, half the patients, that's not good enough. Well, just remember that in practice, patients do better because we usually use a combination therapy, we'll add surgery, we'll have rescue procedures and on and on. And so when you pile it up together patients get really good outcome. And so more and more biologics are becoming the cornerstone of our management for moderate to severe HS. There are a few things to keep in mind that when you target parts of the immune system, namely the TNF response and the IL-17 response, you may put the patient at risk for some infection.

I'd like to tell patients, hey, you have an immune system because you need it. And if I'm going to, I should say, calm it down, modulate it, maybe even suppress it a little bit, then you are more likely to get infections. And so that's the most common one.

But I think these medications have a strong place in the management paradigm for HS. And when you see a patient in the wound center coming on these medications, I think it's important to know that these are good, effective, and overall safe, but you should have a higher index of suspicion for infections, for example.

By the way, not just at the HS sites, they may get upper respiratory infection, which were usually the more common infections that we see, but also a little scratch can turn into a cellulitis before you know it. And so you are a wound healer, you look at the skin, you look at the legs, you look at any area, just keep in mind patients coming on these medications are at risk for that.

Other than that, you can work just as usual. And if you have a surgeon that's going to do a surgery for HS, meaning just cutting the skin, not talking about other surgeries, then more and more we recognize there's pretty good strong evidence, in the case of adalimumab, that patients can safely stay on these medications, even though they are immunosuppressive, they can stay on them during the HS surgery and actually do better. And so these are kind of biologics in a nutshell.

And I think if you see a patient for the first time and they're asking you about a biologic, I think the rational thing to do is to kind of explain what I just explained and then ship them off to a dermatologist after you gave them good wound care.

About the Speaker

Hadar Lev-Tov is an Associate Professor at the Department of Dermatology and Cutaneous Surgery at the University of Miami Miller school of Medicine. He is a Board-certified dermatologist with significant interest in wound healing and medical dermatology. His work is supported in part by a career development award from the Dermatology Foundation, the National Institutes of Health, and industry.

Dr. Lev-Tov completed his residency in Dermatology at Albert Einstein College of Medicine in New York City after completing a research post-doctoral training at UC Davis where he also earned his Master's in clinical research. Dr. Lev-Tov is the director of the wound healing fellowship at the University of Miami, serves as the President Elect for the HS Foundation board of directors (https://www.hs-foundation.org/), is the founding program chair for the Integrative Dermatology Symposium (https://integrativedermatologysymposium.com/) and is the cofounder of the dermatology-focused educational service Learnskin (https://www.learnskin.com/).