Focused updates on pharmacological therapy, surgery, disease management and pathophysiology, including:
Articles covering key advances in HS from the 13th Conference of the European Hidradenitis Suppurativa Foundation (EHSF 2024)
Expert video interviews featuring insights into barriers in surgery, post-operative recurrence, and opinions on the debate between HiSCR and IHS4
Highlights
HS is a specific disease, not only to its course of the disease, but also due to the fact that over time the disease shifts from inflammation to tissue destruction. And once the disease has reached that point, irreversibly damaged tissue can only be removed via surgery. That's the reason why surgery is playing such an important role in the holistic treatment approach of the disease. Well, if you think about the performance of surgery, there are two different types or indications for sure. Even in early disease, if there is a acute abscess formation, you would need a minimal surgical procedure such as incision and drainage or deroofing, for example. And there the goal is to relieve pain. But normally the indication for surgery is the irreversibly damaged tissue, which consists of scars and fistulas in HS. And once you have those lesions, you have a clear indication to excise those. Well, I think there are different barriers when it comes to surgery. I guess if you look at the patient, there's definitely a barrier for a lot of patients to undergo surgery because they had maybe insufficient or inadequate surgery before. So it takes time, and you really have to explain to the patient why surgery is necessary and clearly make sure what is the goal of your surgical procedures. On the other side, once the patient is willing to undergo the procedure, we still face the barrier that there are not a lot of highly experienced surgical centres. So unfortunately in a lot of countries, surgery is not really dealing with HS. And quite sometimes surgeons are not too interested in the disease. And I think these two points are really forming together the whole barrier of surgery nature. Well, the first barrier is really you have to be, you have to show empathy to the patient. I mean, you have to understand why probably he does not want to undergo surgery, probably too bad experience in the past. And you have to do your job and you have to explain clearly why the surgery is so important. The other barrier is even more complex in my opinion. And I think it takes a lot of work, but it's worth to go into intense cooperation with surgical disciplines to find surgeons who are somehow dedicated and interested in the disease and to start just to cooperate. And I think that's, it's long way, but it's worth going in.
View transcript .
During this impressive Thursday, we will receive a lot of information, new developments in pathogenesis, in therapy, in surgery. I want to highlight four points. The first one is regarding the new data we have with the use of bimekizumab. That is interleukin-17A and F blocker that is working against inflammation in HS with real good results in sub-analysis made in phase three clinical trials. But also, with new data we have in available evidence, regarding the usefulness of this could take the option for our patients with HS. In this case, I want also to highlight in the second point that a nice study presented by Linnea Thorlacius so that those patients that are treated with this drug in the first two years of the disease has better results in terms of highest score and also in terms of HS4. We have also new data from secukinumab. Another drug that is blocking interleukin-17A. In this case, with a series of more than 200 patients in real world evidence, we can see an improvement of 15 points compared with data from clinical trials that offer us a new opportunity for treating our patients with HS. With a drug that is now approved for this disease. We have new data from phase two clinical trials with other molecules that blocks other lines like JAK inhibitors, drugs that are blocking neutrophils. But we are still at the beginning of knowing if these molecules are going to help us in the future because we are still are in the phase two. And last but not least, during this first day, we show how imaging techniques can help us in better define how severe is a patient, in better define the responses to medical therapy, and also in order to define the structures of HS that are going to respond to medical therapy. During today, we discuss how important is to personalise the management of our patients with new therapies we have now and how to establish which will be the best integral therapy for each of our patients with HS. I think that the main challenge we have, we want to cover and we are proposing to cover with the presentation we see today, is to make this integral approach of a patient with HS. During a long time, we thought that only the medical therapy for cure on inflammation will be the only option to treat our patients in order to achieve the best results, but now we know that in this case, the biological treatments are a part, an important part, but not the only treatment in order to solve the problem. This internal approach will include four parts, pain control, treatment of comorbidities, treatment of inflammation, and the surgical treatment. In this case, the control of inflammation is exclude because more and more data that we see today suggest a thing that we commented during the last 10 years. The existence of a window of opportunity, the moment in which the patient is going to have the better results with the use of these biologics. That this is at the beginning of the disease as more years of development of the disease. Worse results we're going to achieve with medical therapies and this window of opportunity defined as the moment in which the patient has abscesses without tunnels that are the lesions that are now going to respond to medical therapy appears from the beginning of the disease. As more delay in the treatment, more complication we'll have and less response we'll achieve with the current drugs that we want to offer an alternative way for our patients with HS. I see changes in the doctors, in the dermatologist that this is the most interesting thing. We are waiting for the publication of the last guidelines that are going to offer an update of the different topics regarding treatment for our HS patients, but there is a new step that the doctor will cover that this is a more practical approach. They are putting the focus in how to treat a patient, when to use biologics. These questions need answers, and in this case, they are entering in the world of matching techniques in order to better decide which is the best moment to use the biologics. View transcript .
The comorbidities session was really interesting, because it highlighted the fact that HS is really a systemic disease associated with several comorbidities. We had, for example, communication that suggested dulling the disease has an important comorbidity and it's a follicular comorbidity that could also influence the prognosis of HS. This study was from Spain. We also had studies from Spain, from Ireland, from US highlighting the well-known inflammatory comorbidities such as IBDs. And the question raised by the study is whether we can use systematic screening for IBD in HS patients for example, using calprotectin. It's probably what we are going to. Another important inflammatory comorbidity reported by US team was about non-infectious varieties that extends the field of inflammatory comorbidities. Another very important point in HS patients in the fact that many comorbidities are on the field of cardiovascular disease and metabolic disease. We have a study from US about the association to the NASH liver fibrosis. We also had communication about the increased risk of major cardiovascular event. And it's really something important in the clinical practice to detect and screen for this cardiovascular comorbidities in HS. The interactive session was dedicated to have in the main room, the preliminary session both patients and healthcare providers. And we asked the audience to answer live to several question related to HS clinical case. And we expected, and it is what we observed different answers depending on the quality of those who answered, whether they're patients or HCPs. And the aim of the study was to demonstrate to practitioners that their answer were sometimes not received as pertinent, relevant for the patients. And we also achieve to show to the patients how the physicians are thinking when they ask some question that seem inappropriate. The main aim of this interactive session was to show patients and the physicians that they have different points of view, but they belongs to the same therapeutic team. So that was really important for this interactive session.
Comorbidities and patient–provider viewpoints, with Dr Philippe Guillem View transcript .
Meet the experts
Dr Antonio Martorell
Dr Antonio Martorell is coordinator of the Spanish Hidradenitis Suppurativa Taskforce and responsible for the research and development unit at the Spanish Academy of Dermatology and Venereology. He is also co-founder of Dermus Imaging taskforce and board member of the International Cutaneous Ultrasound Society.
Disclosures: Honoraria from AbbVie, Amgen, Boehringer Ingelheim, Janssen, LEO Pharma, Lilly, L’Oreal, Novartis, Sandoz, and Sanofi.
Professor Falk Bechara
Falk Bechara is Professor of Dermatology, Allergology and Venereology at the Ruhr University Bochum, Germany. He is the past President of the German Society of Dermatologic Surgery (DGDC). Professor Bechara coordinates the Skin Cancer Center at the Ruhr University Bochum, with focus on reconstructive dermatologic surgery, and leads the Clinical Study Center for inflammatory skin diseases.
Disclosures: Honoraria for participation in advisory boards, in clinical trials, and/or as a speaker from AbbVie Deutschland GmbH & Co. KG, AbbVie Inc., Boehringer Ingelheim Pharma GmbH & Co. KG, Celltrion, Dr Wolff, Incyte Corporation, Janssen-Cilag GmbH, Mölnlycke, MoonLake, Novartis Pharma GmbH, and UCB Pharma.
Dr Philippe Guillem
Dr Philippe Guillem is a French surgeon specialising in visceral, digestive and proctologic surgery. He is a member of the French Association of Surgery (AFC), the National French Society for Colo-Proctology (SNFCP), and the European Hidradenitis Suppurativa Foundation (EHSF).
Disclosures: Honoraria from AbbVie, Cicaplus, Inresa, Novartis, and UCB.
