Assessing high-dose infliximab therapy in recalcitrant hidradenitis suppurativa: A retrospective review

Summary: Abstract Body: The utility of infliximab (IFX) at higher dosages (> 10.0 mg/kg) compared to IFX at standard dosages (< 10.0 mg/kg) has not been extensively studied for the treatment of hidradenitis suppurativa (HS). This study aimed to evaluate the efficacy of high-dose IFX in reducing HS disease severity in patients with refractory HS. We performed a retrospective chart review in which 19 HS patients were selected based on inclusion/exclusion criteria. Demographic variables, clinical parameters including HS physician global assessment (HS-PGA) and Numeric Pain Rating Scale (NPRS) scores, and relevant laboratory markers were assessed. 58.0% of patients were female; 58.0% identified as African American and 26.3% identified as hispanic/latino. The mean age was 34.9 ± 10.4, mean BMI was 34.4 ± 8.3, and mean follow-up period was 14.9 ± 7.9 weeks. Compared to the standard IFX dose cohort, patient’s on high-dose IFX experienced a decrease in overall HS-PGA from 4.1 to 3.8 (p<0.02) and a decrease in the maximum reported NPRS score from 7.0 to 3.8 (p<0.01). Additionally, erythrocyte sedimentation rate decreased from 90.0 to 65.1 (p<0.03). No statistical differences between our cohorts were observed for maximum and minimum HS-PGA, overall and minimum NPRS, hemoglobin A1C, leukocyte count, C-reactive protein, interleukin-6, serum IFX levels, and levels of detected IFX antibodies. Notably, no patients reported any significant side effects while taking IFX at either dose. High-dose IFX was associated with clinically meaningful reductions in NPRS scores, however all other parameters exhibited no clinically significant changes. Our results suggest that, while safe, IFX dosages above 10mg/kg provide minimal clinical benefit when treating HS. Future research is needed to confirm our findings on a larger scale as well as investigate alternative inflammatory pathways and/or combination treatments that may be more effective for refractory HS. Zahidul Islam¹, Sarah Romanelli¹, Lana Salloum¹, Richard Rookwood¹, Nicole Schiraldi¹, David Ciocon¹ 1. Dermatology, Montefiore Medical Center, Bronx, NY, United States. Clinical Research: Interventional Research