Case and Research Letter
Ustekinumab for Hidradenitis Suppurativa: A Case Report
Ustekinumab en hidradenitis supurativa: a propósito de un caso
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Santos-Pérez, S. García-Rodicio, M.A. del Olmo-Revuelto, T. Pozo-Román" "autores" => array:4 [ 0 => array:4 [ "nombre" => "M.I." "apellidos" => "Santos-Pérez" "email" => array:1 [ 0 => "marisp243@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "S." "apellidos" => "García-Rodicio" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "M.A." "apellidos" => "del Olmo-Revuelto" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "T." "apellidos" => "Pozo-Román" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Farmacia, Hospital Universitario del Río Hortega, Valladolid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario del Río Hortega, Valladolid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Ustekinumab en hidradenitis supurativa: a propósito de un caso" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 727 "Ancho" => 1410 "Tamanyo" => 164620 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Lesion on the buttocks. A, After 1 month of ustekinumab. B, After 8 months of ustekinumab.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Hidradenitis suppurativa is a chronic and recurrent inflammatory disease that causes disfiguring lesions in areas rich in apocrine sweat glands.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Prevalence is estimated at 1% to 4%, women are affected more often than men (at a ratio of 3:1), and onset is typically in the second or third decade of life.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">While its etiology and pathogenesis are largely unknown, hidradenitis suppurativa is considered a multifactorial disease in which the immune system plays a prominent role. Management of hidradenitis suppurativa should be tailored to lesion severity and distribution assessed according to the Hurley staging system.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> As no specific treatments are available, a wide range of therapeutic options are used with highly variable results. Antibiotics, corticosteroids, and retinoids may be helpful in the early stages and during exacerbations; in advanced or extensive forms of the disease, surgical resection of the affected tissue is imperative.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Biologic agents, particularly tumor necrosis factor (TNF) inhibitors, have been proposed in recent years for recalcitrant forms of hidradenitis suppurativa. Experience with other biologic agents having different mechanisms of action, such as p40 inhibition, is anecdotal.</p><p id="par0020" class="elsevierStylePara elsevierViewall">We report the case of a 50-year-old female smoker with moderate-to-severe hidradenitis suppurativa (Hurley stage II-III). The condition had been diagnosed at age 16 years and had worsened 25 years later. Recent treatments had included a course of isotretinoin and 4 surgical procedures that had involved the face and breasts.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In April 2009, as the condition had proved refractory to treatment, the patient started a new treatment with an 80-mg loading dose of adalimumab, followed by 40 mg every 14 days beginning one week later. Her condition remained stable for 1 year, after which the dosing interval was increased to 21 days. However, 6 months after this change the lesions had worsened and the 14-day regimen was reinstated, with the addition of prednisone for 1 month. Treatment was discontinued 6 months later owing to loss of efficacy (i.e. lesion recurrence) and adverse effects.</p><p id="par0030" class="elsevierStylePara elsevierViewall">After 2 years of adalimumab, the patient was switched to infliximab 5 mg/kg at weeks 0, 2, and 6; however, this regimen was discontinued after 3 doses because the lesions worsened.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In October 2011, because of the severity of her lesions and the lack of other options, off-label treatment was proposed with 45 mg of subcutaneous ustekinumab at weeks 0 and 4, and at 12-week intervals thereafter, and hospital authorization was granted. Disease activity ceased to progress from the start of treatment, although 3 months passed before a clear improvement of the lesions was observed. After 8 months the disease was no longer active (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>). At the time of writing, 1½ years into treatment with ustekinumab, the patient has no active lesions and is tolerating therapy well. During the treatment period there were 2 exacerbations. Both were resolved with a 3-week course of antibiotics (amoxicillin-clavulanic acid at 500 mg/8 h in one case, and rifampicin at 300 mg/12 h in the other), plus prednisone.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Hidradenitis suppurativa is an orphan disease, not because its prevalence (1%-4%) is low, but because there are no therapies that produce sustained clinical remission, let alone any curative effect.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Recent studies in hidradenitis suppurativa have highlighted the role of the immune system and its proinflammatory action, including overexpression of interleukins 12 and 23 and of TNF.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">TNF inhibitors are a therapeutic option for advanced-stage patients who fail to respond to conventional treatment, but response, if achieved, appears to last only as long as treatment is continued. Because of this drawback, as well as their side effects and high cost, TNF inhibitors are relegated to second- or third-line treatment.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Ustekinumab, a monoclonal antibody that blocks interleukins 12 and 23, is rarely used to treat hidradenitis suppurativa, and conclusive evidence on its efficacy is lacking.</p><p id="par0055" class="elsevierStylePara elsevierViewall">In the case described, after the patient's condition had failed to respond well to conventional therapy or 2 different TNF inhibitors, we requested authorization for off-label use of ustekinumab, a drug indicated for moderate to severe psoriasis. Treatment was initiated once the authorization was received, and the patient remains clinically stable at the time of writing after 1½ years’ treatment.</p><p id="par0060" class="elsevierStylePara elsevierViewall">A review of the literature shows that the experience with ustekinumab in hidradenitis suppurativa is anecdotal, with just one 3-case series in which response to treatment was uneven and 2 individual case reports of patients who had other associated inflammatory skin conditions (psoriasis and Behçet disease).<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8–10</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">The data presented suggest that ustekinumab could be a therapeutic option for treatment-refractory hidradenitis suppurativa.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Santos-Pérez MI, García-Rodicio S, del Olmo-Revuelto MA, Pozo-Román T. Ustekinumab en hidradenitis supurativa: a propósito de un caso. Actas Dermosifiliogr. 2014;105:720–722.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1550 "Ancho" => 911 "Tamanyo" => 214591 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Lesions on the abdomen. A, Before ustekinumab. B, After 1 month of ustekinumab. C, After 8 months of ustekinumab.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 727 "Ancho" => 1410 "Tamanyo" => 164620 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Lesion on the buttocks. A, After 1 month of ustekinumab. B, After 8 months of ustekinumab.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hidradenitis suppurativa" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 6 | 2 | 8 |
| 2024 Octubre | 106 | 40 | 146 |
| 2024 Septiembre | 87 | 72 | 159 |
| 2024 Agosto | 111 | 50 | 161 |
| 2024 Julio | 98 | 42 | 140 |
| 2024 Junio | 109 | 41 | 150 |
| 2024 Mayo | 104 | 36 | 140 |
| 2024 Abril | 99 | 21 | 120 |
| 2024 Marzo | 118 | 34 | 152 |
| 2024 Febrero | 103 | 33 | 136 |
| 2024 Enero | 93 | 40 | 133 |
| 2023 Diciembre | 181 | 47 | 228 |
| 2023 Noviembre | 180 | 37 | 217 |
| 2023 Octubre | 125 | 23 | 148 |
| 2023 Septiembre | 104 | 25 | 129 |
| 2023 Agosto | 81 | 28 | 109 |
| 2023 Julio | 95 | 32 | 127 |
| 2023 Junio | 89 | 27 | 116 |
| 2023 Mayo | 103 | 25 | 128 |
| 2023 Abril | 191 | 24 | 215 |
| 2023 Marzo | 128 | 63 | 191 |
| 2023 Febrero | 119 | 25 | 144 |
| 2023 Enero | 127 | 23 | 150 |
| 2022 Diciembre | 152 | 40 | 192 |
| 2022 Noviembre | 92 | 30 | 122 |
| 2022 Octubre | 84 | 22 | 106 |
| 2022 Septiembre | 126 | 42 | 168 |
| 2022 Agosto | 62 | 40 | 102 |
| 2022 Julio | 80 | 31 | 111 |
| 2022 Junio | 85 | 22 | 107 |
| 2022 Mayo | 113 | 30 | 143 |
| 2022 Abril | 162 | 36 | 198 |
| 2022 Marzo | 141 | 39 | 180 |
| 2022 Febrero | 144 | 25 | 169 |
| 2022 Enero | 219 | 46 | 265 |
| 2021 Diciembre | 131 | 31 | 162 |
| 2021 Noviembre | 120 | 42 | 162 |
| 2021 Octubre | 208 | 50 | 258 |
| 2021 Septiembre | 299 | 48 | 347 |
| 2021 Agosto | 121 | 35 | 156 |
| 2021 Julio | 82 | 27 | 109 |
| 2021 Junio | 116 | 34 | 150 |
| 2021 Mayo | 101 | 47 | 148 |
| 2021 Abril | 426 | 63 | 489 |
| 2021 Marzo | 155 | 24 | 179 |
| 2021 Febrero | 95 | 30 | 125 |
| 2021 Enero | 57 | 15 | 72 |
| 2020 Diciembre | 54 | 18 | 72 |
| 2020 Noviembre | 44 | 9 | 53 |
| 2020 Octubre | 39 | 8 | 47 |
| 2020 Septiembre | 29 | 16 | 45 |
| 2020 Agosto | 33 | 22 | 55 |
| 2020 Julio | 38 | 17 | 55 |
| 2020 Junio | 58 | 21 | 79 |
| 2020 Mayo | 39 | 19 | 58 |
| 2020 Abril | 39 | 11 | 50 |
| 2020 Marzo | 28 | 15 | 43 |
| 2020 Febrero | 6 | 1 | 7 |
| 2020 Enero | 0 | 3 | 3 |
| 2019 Diciembre | 4 | 5 | 9 |
| 2019 Noviembre | 0 | 1 | 1 |
| 2019 Septiembre | 4 | 0 | 4 |
| 2019 Agosto | 0 | 1 | 1 |
| 2019 Julio | 0 | 1 | 1 |
| 2019 Junio | 3 | 12 | 15 |
| 2019 Mayo | 0 | 11 | 11 |
| 2019 Abril | 0 | 1 | 1 |
| 2019 Marzo | 2 | 6 | 8 |
| 2019 Enero | 2 | 0 | 2 |
| 2018 Diciembre | 1 | 0 | 1 |
| 2018 Noviembre | 1 | 0 | 1 |
| 2018 Octubre | 3 | 0 | 3 |
| 2018 Septiembre | 6 | 0 | 6 |
| 2018 Agosto | 0 | 1 | 1 |
| 2018 Junio | 0 | 2 | 2 |
| 2018 Mayo | 0 | 3 | 3 |
| 2018 Marzo | 1 | 2 | 3 |
| 2018 Febrero | 49 | 9 | 58 |
| 2018 Enero | 75 | 9 | 84 |
| 2017 Diciembre | 76 | 9 | 85 |
| 2017 Noviembre | 53 | 13 | 66 |
| 2017 Octubre | 40 | 4 | 44 |
| 2017 Septiembre | 36 | 14 | 50 |
| 2017 Agosto | 55 | 16 | 71 |
| 2017 Julio | 54 | 14 | 68 |
| 2017 Junio | 47 | 15 | 62 |
| 2017 Mayo | 51 | 25 | 76 |
| 2017 Abril | 42 | 10 | 52 |
| 2017 Marzo | 32 | 43 | 75 |
| 2017 Febrero | 26 | 9 | 35 |
| 2017 Enero | 36 | 13 | 49 |
| 2016 Diciembre | 48 | 13 | 61 |
| 2016 Noviembre | 44 | 13 | 57 |
| 2016 Octubre | 64 | 13 | 77 |
| 2016 Septiembre | 62 | 7 | 69 |
| 2016 Agosto | 1 | 3 | 4 |
| 2016 Julio | 8 | 7 | 15 |
| 2016 Junio | 15 | 3 | 18 |
| 2016 Mayo | 11 | 3 | 14 |
| 2016 Abril | 9 | 51 | 60 |
| 2016 Marzo | 11 | 4 | 15 |
| 2016 Febrero | 12 | 1 | 13 |
| 2016 Enero | 12 | 7 | 19 |
| 2015 Diciembre | 13 | 2 | 15 |
| 2015 Noviembre | 13 | 0 | 13 |
| 2015 Octubre | 16 | 6 | 22 |
| 2015 Septiembre | 6 | 6 | 12 |
| 2015 Agosto | 20 | 5 | 25 |
| 2015 Julio | 54 | 9 | 63 |
| 2015 Junio | 42 | 8 | 50 |
| 2015 Mayo | 49 | 15 | 64 |
| 2015 Abril | 32 | 11 | 43 |
| 2015 Marzo | 28 | 5 | 33 |
| 2015 Febrero | 33 | 8 | 41 |
| 2015 Enero | 13 | 5 | 18 |
| 2014 Diciembre | 26 | 9 | 35 |
| 2014 Noviembre | 19 | 10 | 29 |
| 2014 Octubre | 25 | 10 | 35 |
| 2014 Septiembre | 16 | 7 | 23 |
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