Effectiveness of Anti-tumor Necrosis Factor Drugs on Hidradenitis Suppurativa: A Systematic Review

Abstract

Hidradenitis suppurativa (HS) is a painful and chronic inflammatory skin disease with no consistently effective treatment, affecting a significant portion of the Western population. HS is characterized by painful nodules, abscesses, tunnels, and scarring in body folds. The immunobiology is poorly understood, therefore resulting in a lack of effective therapies. Despite indications of microbial involvement, antimicrobial treatments have shown inconsistent and temporary results. Recent studies have identified dysregulated immune responses as a key factor in HS. This has led to the use of biologic agents, most notably adalimumab, which is currently the only FDA-approved therapy for HS. Due to the limited understanding of immune dysregulation in HS, ongoing clinical trials are adapting treatments from other skin conditions, such as psoriasis. As a result, researchers look to other skin conditions with better-understood pathophysiologies, such as psoriasis, as a starting point for developing treatments for HS. While adaptation can offer some benefits, such as immediate treatment options, the lack of specificity can lead to side effects that are not well tolerated, and long-term efficacy may be uncertain. Therefore, there is a pressing need for a foundational understanding of HS's immune dysregulation. Current ongoing research is exploring other options, such as therapies targeting IL-17, in addition to anti-TNF therapies, which have shown the potential to be more effective. With new options emerging, it is essential to evaluate the current performance of anti-TNF drugs in treating HS. This review was conducted to thoroughly assess the effectiveness of these therapies, offering a detailed analysis to inform future research and clinical practice. The objective is to determine whether anti-TNF drugs continue to be a strong treatment option or if newer therapies might lead to better outcomes for patients.

Keywords: adalimumab; anti-il-17; anti-tnf; etanercept; hidradenitis suppurativa; il-17.

Figure 1. Identification of the inclusion and exclusion criteria progression