Title: Secukinumab for treating moderate to severe hidradenitis suppurativa [ID4039]
Funder: Department of Health and Social Care

Abstract: Hidradenitis suppurativa (HS), also known as acne inversa or Verneuil's disease, is a chronic disorder of the skin. HS is caused by blocked hair follicles which are connected to apocrine sweat glands. This stops sweat from escaping onto the skin and leads to the formation of pus-filled abscesses. These are painful and can cause itching, redness, burning and eventually scarring, which can limit function and may require surgery to reverse. In severe cases the pus tunnels deep under the surface of the skin and forms widespread networks of interconnected channels that can break out on the surface and leak pus. Symptoms begin around puberty and most commonly appear in the second or third decade of life. The disease affects areas with apocrine sweat glands such as the groin and genitals, buttocks and inner thighs, armpits and below the breasts. The cause of HS is unclear but may be hormonal or the result of an underlying autoimmune disorder. _x000D_ _x000D_ HS affects around 1 in 130 people in the United Kingdom, although approximately one in three cases go unrecognised. 1 There are approximately 435,000 people with HS in England.[1],[2] The disease is more common in women than in men. People of African-Caribbean family background have a higher incidence than people of European family background. _x000D_ _x000D_ There are no tests used to diagnose HS and a diagnosis is usually based on the typical signs or symptoms of the disease, although a GP may do tests to rule out other conditions with similar signs and symptoms. [3] The British Association of Dermatologists guidelines recommend initial treatment with oral tetracyclines (such as doxycycline or lymecycline), followed by combination treatment with oral clindamycin and rifampicin in people whose disease has not responded. Retinoids (such as acitretin) and dapsone are recommended for people whose disease does not respond to antibiotic therapy.[4] NICE technology appraisal 392 recommends adalimumab as an option for treating active moderate to severe HS in adults whose disease has not responded to conventional systemic therapy. An NHS England Clinical Commissioning Policy states that there is not enough evidence to make infliximab available to treat HS. Surgery may also be considered for people with chronic HS that cannot be controlled by medicine.[3],[4]_x000D_ _x000D_ References_x000D_ 1. Ingram JR, Jenkins-Jones S, Knipe DW et al. (2018) Population-based Clinical Practice Research Datalink study using algorithm modelling to identify the true burden of hidradenitis suppurativa. British Journal of Dermatology 178(4):917-924._x000D_ 2. Office for National Statistics (25 June 2021) Population estimates for the UK, England and Wales, Scotland and Northern Ireland: mid-2020_x000D_ 3. NHS (2019). Hidradenitis Suppurativa. Accessed May 2022._x000D_ 4. Ingram JR, Collier F, Brown D et al. (2019) British Association of Dermatologists guidelines for the management of hidradenitis suppurativa (acne inversa) 2018. British Journal of Dermatology 180(5):1009-1017.

Lay abstract: To appraise the clinical and cost effectiveness of secukinumab within its marketing authorisation for treating moderate to severe hidradenitis suppurativa.

Research activity codes: 6.1 PHARMACEUTICALS
Health categories: SKIN