Tildrakizumab shows potential in long-term treatment of severe HS

By Michael Woodhead

23 Mar 2021

A higher dose regimen of the IL-23 inhibitor tildrakizumab has potential for reducing disease severity in the longer term for patients with severe hidradenitis suppurativa (HS), experience at one Australian centre suggests.

Reporting on the early experience with tildrakizumab in nine patients with severe HS, dermatologists at Royal Melbourne Hospital, said it appeared to be effective and well tolerated when used for up to 15 months.

Initially, the drug was used in a starting dose of 100 mg injection at weeks 0 and 4 in five patients then and 200 mg every four weeks thereafter. Since it was found to be well tolerated, subsequent patients were started on 200 mg every four weeks at baseline.

Writing in the Australasian Journal of Dermatology, Dr Yonatan Kok and colleguaes in the Department of Dermatology described how tildrakizumab was accessed through a compassionate pathway for nine patients.

All but one had Hurley stage 3 disease and four had received prior treatment with adalimumab, while one had anakinra and infliximab. All patients had prior systemic therapy.

They found that after starting treatment with tildrakizumab, patients showed a statistically significant reduction in mean abscess and nodule count at months two and five, compared to pre-treatment levels. IN the four patients who continued for treatment up to 15 months there was  astatistically significant reduction in mean abscess and nodule count of 23.50 (P = 0.032).

Two patients were able to cease all their concurrent medications during the study period. Two patients required deroofing procedures, and two patients had incision and drainage of an abscess.

Treatment was also associated with improvement in quality of life, as measured by DLQI scores at 12 months, and also a trend in improvements in VAS scores throughout the study, but this did not reach statistical significance.

Treatment appeared to be well tolerated, with no injection site reactions, upper respiratory tract infections or haematologic, hepatic or renal laboratory abnormalities attributed to tildrakizumab.

The study investigators noted that there was no control group and patients continued to have concomitant medications such as antibiotics and procedures during the study, which may be partly responsible for some of the improvements observed in our patients.

Nevertheless they concluded that the study suggested that higher dose tildrakizumab can be well tolerated and efficacious in the longer term in reducing disease severity for patients with severe HS.

However larger randomised controlled trials were needed to validate the results of the study, they added.

Disclosure: The authors declared that Sun Pharma had no role in the study design, data collection, data analysis, interpretation of data, writing of the manuscript or publication decisions.

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