Azathioprine in hidradenitis suppurativa with inflammatory phenotype: a case series of 11 patients.

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic inflammatory disease that negatively impacts the quality of life of patients. It presents as deep-seated nodules, abscesses, fistulae, sinus tracts, and scars in the axilla, inguinal area, submammary folds, and perianal area. Recently, two phenotypes have been described: a follicular phenotype and an inflammatory phenotype. Numerous medical treatments are available for hidradenitis suppurativa, with particular importance of antitumor necrosis factor antibodies. Due to the association of HS with other conditions with a pro-inflammatory state, particularly Crohn's disease, it has been suggested that azathioprine may have a role in the treatment of HS. OBJECTIVE: To assess the effectiveness of azathioprine monotherapy in patients with moderate-severe HS. METHODS: We retrospectively studied patients with HS treated with azathioprine in monotherapy. We performed both clinical and ultrasound evaluation at baseline as well as in the follow-up visits. Their baseline score on the iHS4 and DLQI scales and 12-16 weeks after starting the treatment were compared. We also registered the number of patients who achieved HiSCR. RESULTS: Six patients presented significant improvement, reducing their score in iHS4 and DLQI scales and achieving HiSCR. Another patient had clinical improvement, meaning reduction in iHS4 and DLQI, but without achieving HiSCR. Two patients stopped the treatment before week 12 because of adverse events. The remaining two patients presented no improvement. The median (Q3-Q1) baseline iHS4 score was 6 (12-6), and follow-up iHS4 score, 4 (6-2), being these differences statistically significant (P = 0.006). Median (Q3-Q1) baseline DLQI scores and 12-16 weeks after treatment were 17 (23-11) and 14 (18-9) although statistically nonsignificant (P = 0.099). CONCLUSION: We present a case series of 11 patients treated with azathioprine with good clinical and ultrasonographic response. We suggest that azathioprine may benefit a certain patient profile with the inflammatory phenotype.

Drug survival, discontinuation rates, and safety profile of secukinumab in real-world patients: a 152-week, multicenter, retrospective study.

BACKGROUND: Psoriasis is a chronic systemic disease that requires long-term management. Despite data on follow-up studies going back 5 years, little is known about the condition's sustainability based on patient profiles. The aim of this study was to analyze drug survival and discontinuation rates for secukinumab treatment under real-world conditions. PATIENTS AND METHODS: Patients with moderate-to-severe plaque psoriasis treated in the dermatology department of five Spanish medical centers between 2015 and 2019 were included in our retrospective study. Drug survival was assessed with Kaplan-Meier analysis plots and multivariate regression. RESULTS: In total, 171 treated patients were retrospectively recorded and analyzed for 152 weeks (37.40% had been diagnosed with psoriatic arthritis [PsA]). The discontinuation rate in the PsA group was 14.10% vs. 12.10% among those who had no PsA. The mean survival time of discontinuation was 63 weeks for PsA vs. 65 weeks for no PsA (P = 0.913). Secukinumab's estimated mean survival in PsA patients was 86% (estimated mean survival time 130 weeks) vs. 88% (estimated mean survival time of 133 weeks) in non-PsA patients (P = 0.676). CONCLUSION: The mean survival time of patients in secukinumab treatment was comparable in all patient profiles and better than the data found in clinical trials and real-life studies.