Autoimmune diseases

Aussie HS patients show good responses to JAK inhibitor therapy

Australian patients with moderate to severe hidradenitis suppurativa (HS) have shown high levels of clinical response to treatment with the JAK inhibitor upadacitinib.

In a retrospective observational study involving 20 patients treated at a single centre, dermatologists at Liverpool Hospital, Sydney, reported that most showed significant improvement within four weeks of treatment, which appeared to be well tolerated up to five months.

Dr John Frew and colleagues used daily doses of 15 mg of upadacitinib in patients with Hurley Stage 2 (45%) or Stage 3 (55%) HS, reviewed after four weeks, 12 weeks and 24 weeks. One third of patients who did not show a clinical response (Hidradenitis Suppurativa Clinical Response, HiSCR) at four weeks had upadacitinib doses escalated to 30 mg daily.

Within four weeks, 75% of patients had achieved a 50% clinical response (HiSCR50) with all patients achieving HiSCR50 at week 12 and maintained at week 24.

Rates of 75% response (HiSCR75) were 30% at week 4, increasing to 95% at week 12 and maintained at week 24.

Clinical response rates of 90% (HiSCR90) were achieved by four patients (20%) at week 4, and by six (30%) at week 12, and maintained at week 24.

Similarly, improvements were seen in HS severity as measured by IHS4 scores, as well as in pain and quality of life scores (DLQI) by week 4.

While 20% of patients experienced flares, the study investigators said it was notable that all patients on upadacitinib reported new abscesses in contrast to their previous experience of flares with smaller nodules, “possibly implying a differential immunological basis for the development of abscesses compared with nodules and tunnels”.

In terms of safety, one patient had reactivation of VZV, which was treated with oral valacyclovir without the need to stop upadacitinib therapy.

Other side effects included mild, transient transaminitis in two patients that spontaneously resolved, and elevated creatine kinase levels (80% of patients) with no musculoskeletal symptoms or myoglobinuria.

The treatment period was 2021–2022 pandemic when 60% of patients received COVID vaccination and four (20%) had COVID with mild symptoms.

Dr Frew and colleagues said the findings from a real-world setting showed that a JAK-1 selective inhibitor could provide positive clinical outcomes for patients with HS who may have the greatest need for novel therapies, such as those with greater than 20 draining tunnels.

The trial was independently funded and the findings are published in the Journal of the American Academy of Dermatology.

Meanwhile another Australian study has shown that HS has a profound impact on quality of life of patients, exceeding that of non-dermatological conditions such as myocardial infraction or inflammatory bowel disease.

DLQI scores obtained from 89 HS patients in Queensland showed that HS had ‘a very large impact’  exceeding that of conditions such as severe psoriasis.

Over one third of participants were not currently working, in keeping with the known impact of HS on absenteeism. There was also an association between HS symptoms and depression, anxiety and embarrassment during sexual activity.

“Despite this, there remains a lack of health-care resources, education and a greater delay to diagnosis compared to other medical diseases with less impact to quality of life,” said clinicians from the Dermatology Department, Princess Alexandra Hospital, Brisbane.

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