Efficacy and safety of secukinumab in conjunction with surgery in moderate to severe hidradenitis suppurativa

Abstract

Figures

Differences in IHS4 scores of 4 anatomical sites between week 52 and baseline after treatment with secukinumab combined with surgery. ∗∗*P* < .01, ∗∗∗*P* < .001. *IHS4*, International Hidradenitis Suppurativa Severity Score System.

Full text

To the Editor: Secukinumab, an interleukin-17A inhibitor, improved outcomes in moderate-to-severe hidradenitis suppurativa (HS) in 2 phase 3 trials.1 Surgery remains essential for established tunnels, and expert guidance supports integrating medical and surgical approaches in selected patients.2 However, real-world evidence on efficacy of secukinumab combined with surgery is limited. We evaluated effectiveness and safety of secukinumab in conjunction with deroofing and/or excision in a retrospective cohort.

Adults (aged ≥ 18 years) with Hurley stage II to III HS treated at our center (2021-2024) were eligible if they received secukinumab plus local/wide deroofing and/or excision and had complete 52-week follow-up. Secukinumab was given as 300 mg weekly for 5 weeks, then every 4 weeks thereafter. Timing varied: 13 patients initiated secukinumab 3 months preoperatively, 8 during the perioperative period, and the remainder postoperatively. The primary endpoint was change in the International Hidradenitis Suppurativa Severity Score System3 from baseline to week 52, assessed by anatomical domain (head/face/neck, axillae, groin, and buttocks/anogenital). Secondary end points were Hidradenitis Suppurativa Clinical Response (HiSCR),4 site-specific HiSCR (Local HiSCR), and patient-reported outcomes (Visual Analogue Scale pain, Dermatology Life Quality Index, and Work Productivity and Activity Impairment Questionnaire [General Health v1.0]).

Seventy patients were included (Table I). Most participants were men (81.4%) with mean age 28.8 ± 9.8 years, and 74.3% had Hurley stage III disease. The cohort was clinically challenging: most had prior antibiotic exposure and some had inadequate response to adalimumab. At week 52, results showed that mean International Hidradenitis Suppurativa Severity Score System decreased significantly across all anatomical regions (all P < .001, Fig 1). Overall, HiSCR was achieved by 65/70 patients (92.9%); rates were similar in single-site and multisite diseases (93.5% vs 91.7%; P = .65). Local HiSCR ranged from 85.7% to 87.8% across regions (Supplementary Table I, available via Mendeley at https://data.mendeley.com/datasets/stg3trtwm8/1). Patient-reported outcomes improved from baseline to week 52: Visual Analogue Scale pain 7.2 ± 1.7 to 1.5 ± 1.2, Dermatology Life Quality Index 19.8 ± 5.6 to 6.1 ± 4.6, and Work Productivity and Activity Impairment Questionnaire [General Health v1.0] 10.8 ± 4.2 to 3.5 ± 2.6 (all P < .001, Supplementary Table II, available via Mendeley at https://data.mendeley.com/datasets/xm4hk98k2h/1).Table IPatient’s demographics and clinical featuresParametersValuesSex, n (%) Men57 (81.4) Women13 (18.6)Age, mean ± SD, y28.8 ± 9.8BMI, mean ± SD, kg/m^2^26.6 ± 4.1Disease course, mean ± SD, y5.1 ± 4.4Smoking habit, n (%)20 (28.6)Family history, n (%)6 (8.6)Hurley stage, n (%) II18 (25.7) III52 (74.3)Number of affected areas∗, n (%) 146 (65.7) 219 (27.1) 32 (2.9) 43 (4.3)Comorbidities, n (%) Hyperuricemia15 (21.4) Hyperlipidemia and fatty liver12 (17.1) Acne10 (14.3) Psychiatric disorder‡4 (5.7) Diabetes3 (4.3) Hypertension2 (2.9) Psoriasis1 (1.4) Systemic lupus erythematosus1 (1.4)Previous treatment, n (%) Antibiotics†59 (84.3) Glucocorticoid12 (17.1) Isotretinoin21 (30.0) Adalimumab13 (18.6) Surgery ± PDT23 (32.9)BMI, Body mass index; PDT, photodynamic therapy; SD, standard deviation.∗Head, face, neck, axillae, groin, buttock, and anus.†Includes topical and oral antibiotics, such as doxycycline, clindamycin, rifampicin, and metronidazole.‡Anxiety, depression, and obsessive-compulsive disorder (OCD).Fig 1. Differences in IHS4 scores of 4 anatomical sites between week 52 and baseline after treatment with secukinumab combined with surgery. ∗∗P < .01, ∗∗∗P < .001. IHS4, International Hidradenitis Suppurativa Severity Score System.

Adverse events occurred in 17/70 patients (24.3%), including 14 considered treatment-related. The most common treatment-related events were upper respiratory tract infection (n = 5), HS flares (n = 5), and delayed wound healing (n = 4). No serious adverse events occurred, and no patient discontinued secukinumab for safety.

Limitations include retrospective design, lack of a control arm, and assessments limited to baseline and week 52. Nonetheless, in a real-world cohort of moderate-to-severe HS undergoing deroofing or excision, secukinumab used in conjunction with surgery was associated with marked clinical improvement and meaningful quality-of-life gains without new safety signals. Perioperative biologic–surgery integration has also been supported in a randomized trial of adalimumab plus surgery.5 Prospective controlled studies should define optimal timing around surgery and quantify incremental benefit over either modality alone.

Conflicts of interest

None disclosed.