The efficacy and tolerability of tetracyclines and clindamycin plus rifampicin for the treatment of hidradenitis suppurativa: Results of a prospective European cohort study
Authors: Kelsey R. van Straalen, Thrasyvoulos Tzellos, Phillipe Guillem, Farida Benhadou, Carlos Cuenca-Barrales, Mathilde Daxhelet, Mathieu Daoud, Ourania Efthymiou, Evangelos J. Giamarellos-Bourboulis, Gregor B.E. Jemec, Alexandros C. Katoulis, Anke Koenig, Elizabeth Lazaridou, Angelo V. Marzano, Łucas Matusiak, Alejandro Molina-Leyva, Chiara Moltrasio, Andreas Pinter, Concetta Potenza, Jorge Romaní, Ditte M. Saunte, Nevena Skroza, Dimitra Stergianou, Jacek Szepietowski, Anastasia Trigoni, Eva Vilarrasa, Hessel H. van der Zee
Journal: Journal of the American Academy of Dermatology (2021)

BackgroundTetracyclines and clindamycin plus rifampicin combination therapy are both considered first-line therapy in current hidradenitis suppurativa guidelines. However, evidence for their efficacy is drawn from small studies, often without validated outcomes.ObjectiveTo assess the 12-week efficacy of oral tetracyclines and a combination of clindamycin and rifampicin.MethodsA prospective, international cohort study performed between October 2018 and August 2019.ResultsIn total, 63.6% of the included 283 patients received oral tetracyclines, and 36.4% were treated with clindamycin and rifampicin. Both groups showed a significant decrease in International Hidradenitis Suppurativa Severity Score System from baseline (both P < .001). The Hidradenitis Suppurativa Clinical Response (HiSCR) was achieved in 40.1% and 48.2% of patients, respectively (P = .26). Patient characteristics or disease severity were not associated with the attainment of HiSCR or the minimal clinically important differences for the Dermatology Life Quality Index and pain.LimitationsCohort study. Respectively, 23.9% and 19.4% of patients had to be excluded from the HiSCR analysis for the tetracycline and combination therapy group because of a low abscess and nodule count at baseline.ConclusionThis study shows significant efficacy of both tetracycline treatment and clindamycin and rifampicin combination therapy after 12 weeks in patients with hidradenitis suppurativa. No significant differences in efficacy were observed between the 2 treatments, regardless of disease severity. Tetracyclines and clindamycin plus rifampicin combination therapy are both considered first-line therapy in current hidradenitis suppurativa guidelines. However, evidence for their efficacy is drawn from small studies, often without validated outcomes. To assess the 12-week efficacy of oral tetracyclines and a combination of clindamycin and rifampicin. A prospective, international cohort study performed between October 2018 and August 2019. In total, 63.6% of the included 283 patients received oral tetracyclines, and 36.4% were treated with clindamycin and rifampicin. Both groups showed a significant decrease in International Hidradenitis Suppurativa Severity Score System from baseline (both P < .001). The Hidradenitis Suppurativa Clinical Response (HiSCR) was achieved in 40.1% and 48.2% of patients, respectively (P = .26). Patient characteristics or disease severity were not associated with the attainment of HiSCR or the minimal clinically important differences for the Dermatology Life Quality Index and pain. Cohort study. Respectively, 23.9% and 19.4% of patients had to be excluded from the HiSCR analysis for the tetracycline and combination therapy group because of a low abscess and nodule count at baseline. This study shows significant efficacy of both tetracycline treatment and clindamycin and rifampicin combination therapy after 12 weeks in patients with hidradenitis suppurativa. No significant differences in efficacy were observed between the 2 treatments, regardless of disease severity.