Adalimumab for treatment of hidradenitis suppurativa during the COVID-19 pandemic: Safety considerations
Authors: Alecia Blaszczak, John C.L. Trinidad, Alexander M. Cartron
Journal: Journal of the American Academy of Dermatology (2020)

To the Editor: With the peak of coronavirus disease 2019 (COVID-19) expected to occur in many regions of the United States in the coming weeks to months, physicians and patients alike are concerned about the use of immunosuppressive, biologic agents given the increased infection risk. A recent Letter to the Editor highlighted the risk of total infections, upper respiratory tract infections, and nasopharyngitis in patients with psoriasis on immunomodulating biologic therapy.1Lebwohl M. Rivera-Oyola R. Murrell D.F. Should biologics for psoriasis be interrupted in the era of COVID-19?.J Am Acad Dermatol. 2020; 82: 1217-1218Abstract Full Text Full Text PDF PubMed Scopus (131) Google Scholar Similar to psoriasis, hidradenitis suppurativa (HS) is an inflammatory skin disease managed effectively with biologic agents when disease burden is high. Adalimumab, a tumor necrosis factor-α inhibitor, is currently the only United States Food and Drug Administration (FDA)-approved drug for moderate to severe HS. Compared with patients with psoriasis, patients with HS generally require higher doses of adalimumab, especially during treatment initiation.2United States Food and Drug Administration2015Google Scholar Although current data are not available for COVID-19 risk in patients with HS, data from the Efficacy and Safety Study of Adalimumab in Treatment of Hidradenitis Suppurativa (PIONEER) I and II phase 3 clinical trials may provide important insight into the risk of infectious complications in this unique patient population.3Kimball A.B. Okun M.M. Williams D.A. et al.Two phase 3 trials of adalimumab for hidradenitis suppurativa.N Engl J Med. 2016; 375: 422-434Crossref PubMed Scopus (498) Google Scholar Table I highlights the risk of total infections, upper respiratory tract infections, and pharyngitis in patients with HS on adalimumab vs placebo from the data published in the PIONEER I and II trials.3Kimball A.B. Okun M.M. Williams D.A. et al.Two phase 3 trials of adalimumab for hidradenitis suppurativa.N Engl J Med. 2016; 375: 422-434Crossref PubMed Scopus (498) Google Scholar In patients with HS taking adalimumab, there is a modest increased risk of total infections and nasopharyngitis by 2.5%, on average, with no difference in the risk of upper respiratory tract infections. These results demonstrate that, in general, there was minimal difference between rates of respiratory infections in patients with HS on adalimumab vs placebo.Table IRisks of total infections, upper respiratory infections, and nasopharyngitis in hidradenitis suppurativa patients taking adalimumab vs placebo∗Data from period 1 of the Efficacy and Safety Study of Adalimumab in Treatment of Hidradenitis Suppurativa (PIONEER) I and II trials.TrialPatients, No.Total infections, No. (%)Upper respiratory tract infections, No. (%)Nasopharyngitis, No. (%)AdalimumabPlaceboAdalimumabPlaceboAdalimumabPlaceboAdalimumabPlaceboPIONEER I15215340 (26)32 (21)4 (2.6)5 (3.3)16 (10.5)9 (5.9)PIONEER II16316337 (23)36 (22)9 (5.5)8 (4.9)10 (6.1)9 (5.5)Total31531677 (24)68 (21.5)13 (4.1)13 (4.1)26 (8.2)18 (5.7)∗ Data from period 1 of the Efficacy and Safety Study of Adalimumab in Treatment of Hidradenitis Suppurativa (PIONEER) I and II trials. Open table in a new tab Much like data regarding the effect of immunosuppressive drugs on patients with psoriasis, extrapolating data from the PIONEER I and II trials to susceptibility to coronavirus infection is difficult. Nonetheless, dermatologists may use these data to make informed treatment decisions for patients with HS during the ongoing COVID-19 pandemic. Should biologics for psoriasis be interrupted in the era of COVID-19?Journal of the American Academy of DermatologyVol. 82Issue 5PreviewTo the Editor: With daily media warnings of a looming pandemic, physicians are understandably concerned about immunosuppressive or immunomodulating effects that might render patients receiving biologic therapies more susceptible to COVID-19 infection. At this early stage, we do not have specific data about susceptibility to the virus, but we have data on infectious complications for biologic therapies from their pivotal trials for psoriasis. Full-Text PDF