Elevated infliximab antibodies in hidradenitis suppurativa may be predictive of anaphylaxis risk

Summary: Background: Infliximab (IFX), a TNF-α inhibitor, is considered a standard of care for advanced hidradenitis suppurativa (HS). Containing both human and mouse protein; the latter often induces IFX antibodies, that degrade its efficacy and may lead to anaphylaxis. Previous studies describe antibodies during IFX-induced reactions in rheumatoid arthritis, vasculitis and Crohn's disease (1,2). Objective: To analyze the predictive value of IFX antibodies regarding drug efficacy and anaphylaxis in HS. Methods: In a cohort of 48 HS patients tested for IFX levels, we identified eight patients (16.6%) who experienced anaphylaxis. Serum antibodies to IFX were analyzed in the context of demographic data and disease severity (hidradenitis suppurativa physician global assessment [HSPGA] with HSPGA ≥3 reflecting advanced disease). Results: Of eight HS patients who experienced anaphylaxis, the mean age was 45 years; 6 females; 4 Black, 3 Spanish/Hispanic/Latino, 1; White; and, mean body mass index of 36.6. Hypersensitivity during IFX infusions included throat tightening, increased heart rate, shortness of breath, and hives. Infliximab antibody levels were positive in 7 of 8 (88%) patients. Mean HSPGA score was 3. Discussion: The presence of IFX antibodies, a likely risk factor for hypersensitivity, including anaphylaxis encountered in 16.6% of our cohort, implies the desirability of substituting a fully humanized IFX congener, such as golimumab (Simponi Aria®, Janssen) (3). The high HSPGA in our cohort suggests that antibody formation may contribute to disease severity by neutralizing IFX efficacy. The loss of IFX therapy is devastating for HS patients with high BMI, because self-injectable biologics, such as humira, lose efficacy in this setting (4). There has been no evidence of cross reactivity or immunogenicity between infliximab and its fully humanized counterpart, golimumab (5). While limited by small sample size, our findings support prompt reassessment of treatment options once IFX antibodies are detected. Aarthi Parvathaneni¹, Hansen Tai¹, Khyla Hill¹, Steven Cohen¹ 1. Dermatology, Weill Cornell Medicine, New York, NY, United States. Clinical Research: Epidemiology and Observational Research