The efficacy and tolerability of tetracyclines and clindamycin plus rifampicin for the treatment of hidradenitis suppurativa: Results of a prospective European cohort study

Kelsey R Van Straalen,Phillipe Guillem,Eva Vilarrasa,Anke Koenig,Jorge Romaní,Hessel H Van Der Zee,Chiara Moltrasio,Concetta Potenza,Mathieu Daoud,Ourania Efthymiou,Farida Benhadou,Anastasia Trigoni,Thrasyvoulos Tzellos,Andreas Pinter,Elizabeth Lazaridou,Nevena Skroza,Dimitra Stergianou,Jacek C Szepietowski ,Evangelos J Giamarellos‐Bourboulis ,Łukasz Matusiak ,Alejandro Molina‐Leyva ,Alexandros Katoulis ,Carlos Cuenca‐Barrales ,Ditte Marie Lindhardt Saunte ,Angelo Valerio Marzano ,M Daxhelet ,Gregor B E Jemec

doi:10.1016/j.jaad.2020.12.089

Abstract

Tetracyclines and clindamycin plus rifampicin combination therapy are both considered first-line therapy in current hidradenitis suppurativa guidelines. However, evidence for their efficacy is drawn from small studies, often without validated outcomes. To assess the 12-week efficacy of oral tetracyclines and a combination of clindamycin and rifampicin. A prospective, international cohort study performed between October 2018 and August 2019. In total, 63.6% of the included 283 patients received oral tetracyclines, and 36.4% were treated with clindamycin and rifampicin. Both groups showed a significant decrease in International Hidradenitis Suppurativa Severity Score System from baseline (both P<.001). The Hidradenitis Suppurativa Clinical Response (HiSCR) was achieved in 40.1% and 48.2% of patients, respectively (P=.26). Patient characteristics or disease severity were not associated with the attainment of HiSCR or the minimal clinically important differences for the Dermatology Life Quality Index and pain. Cohort study. Respectively, 23.9% and 19.4% of patients had to be excluded from the HiSCR analysis for the tetracycline and combination therapy group because of a low abscess and nodule count at baseline. This study shows significant efficacy of both tetracycline treatment and clindamycin and rifampicin combination therapy after 12weeks in patients with hidradenitis suppurativa. No significant differences in efficacy were observed between the 2 treatments, regardless of disease severity.

Highlights

Tetracyclines and clindamycin plus rifampicin combination therapy are both considered first-line therapy in current hidradenitis suppurativa guidelines
Current guidelines and consensus statements on the treatment of HS consistently d Evidence for the efficacy of tetracyclines and clindamycin plus rifampicin in hidradenitis suppurativa is drawn from small studies, often without validated outcomes
D Both treatment with tetracyclines and clindamycin combined with rifampicin show significant efficacy in patients with hidradenitis suppurativa

Summary

Methods

A prospective, international cohort study performed between October 2018 and August 2019. A detailed protocol including study design, recommend 2 types of antiinclusion and exclusion biotic therapy as the first-line treatment.[4,5,6,7,8,9,10,11] Oral tetracyclines, such as doxycycline criteria, HS treatment guidelines, assessment schedule, and timeline was sent out and minocycline, are recommended as a first-line therapy for mild to moderate HS.[4,5,6,7,8,9,10,11] The combination of clindamycin and rifampicin is favored as a in October 2018 to all centers that previously participated in an European Hidradenitis Suppurativa Foundation consortium study.[5,11] first-line therapy for moderate to severe HS but is recommended as a second-line therapy for Participants mild to moderate disease unresponsive to oral tetracyclines before biologic treatment.[4,5,6,7,8,9,10,11] Following this protocol, patients who were treated according to the current international guide-.

Results

Discussion

Conclusion