Treatment of hidradenitis suppurativa with brodalumab in biologic treatment failures: experiences from a specialty clinic

Hidradenitis suppurativa (HS) is characterized by increased interleukin (IL)-17A/C/F. Two open-label trials of brodalumab, an IL-17 receptor antagonist, have been completed, with 8 of 10 patients receiving brodalumab fortnightly and 10 of 10 patients receiving brodalumab weekly achieving 75% Hidradenitis Suppurativa Clinical Response. All patients were biologic 'experienced' but were not reported to have failed biologic treatment. We report outcomes for eight patients with HS who had failed at least one biologic, treated with brodalumab 210 mg fortnightly, to provide real-world evidence. Four of eight patients remain on brodalumab, with a mean treatment duration of 11.3 months. All patients who remain on brodalumab subjectively report continued treatment efficacy. The mean Dermatology Life Quality Index reduced from 20.6 to 16.8 at week 16. All patients required concurrent antibiotics due to flares. Brodalumab may be effective in patients who have previously failed multiple biologics, but efficacy in our real-world study falls short of the two open-label trials. This may reflect severe treatment-resistant disease. In the absence of further licensed treatments for HS, brodalumab may be a good option following adalimumab failure. Two open-label trials of brodalumab, an interleukin 17 receptor antagonist, have been completed in hidradenitis suppurativa (HS), with 8 of 10 patients receiving brodalumab fortnightly and 10 of 10 patients receiving brodalumab weekly achieving 75% Hidradenitis Suppurativa Clinical Response. We report outcomes for eight patients, who previously failed at least one biologic, treated in a specialty HS clinic with brodalumab 210 mg fortnightly, with half of patients experiencing a subjective clinical response. Brodalumab may be effective in patients who have previously failed multiple biologics, but in this real-world study efficacy falls short of the two open-label trials.