Evaluation of barriers to therapeutic drug monitoring in the management of hidradenitis suppurativa

Abstract

Hidradenitis Suppurativa (HS) is a chronic relapsing inflammatory disease that results in painful, recurring subcutaneous nodules in skin folds and leads to a physical and psychosocial burden on patients. Current treatments are shifting towards biologics that target the exaggerated immune response. Unfortunately, even under optimal biologic therapy, some patients fail to respond. For example, about 50% of patients treated with adalimumab fail to respond (primary failure).¹ Some initial responders lose efficacy over time (secondary failure). One factor that may lead to treatment failure is immunogenicity and anti‐drug antibodies (ADA). In phase 3 trials, at least one exposure to adalimumab resulted in overall ADA prevalence of 6.5% and prolonged exposure resulted in 10.1%. ADA presence is consistently associated with lower serum drug concentrations.² ADA can occur with other biologic drugs however the relevance to HS management is unclear.³