Department of Dermatology, Academic Medical Center, University of Amsterdam, The Netherlands.
J Dermatolog Treat. 2013 Oct;24(5):392-404. doi: 10.3109/09546634.2012.674193. Epub 2012 Apr 12.
To provide an overview of the current evidence regarding off-label treatment of hidradenitis suppurativa (HS) with TNF-α inhibitors, a systematic search was performed in MEDLINE, EMBASE and CENTRAL. Any type of original article concerning HS patients treated with infliximab, etanercept and/or adalimumab was included. No language restriction was applied. After full-text screening 65 studies involving 459 patients met the inclusion criteria and were subjected to data extraction. Four randomized controlled trials (RCTs) were available, and the remainders were case series or reports. Only RTCs were subjected to methodological quality assessment. Based on efficacy data extracted from the case reports, a moderate to good response was seen in 82% of the patients treated with infliximab, 76% of the patients treated with adalimumab, and 68% of the patients treated with etanercept. Due to the moderate level of evidence only a weak recommendation can be provided. If conventional treatment options fail, the use of TNF-α inhibitors can be a useful supplement for the treatment of recurrent severe HS. Infliximab should be preferred based on the most encouraging results regarding efficacy and expenses. Also adalimumab seems promising when administered in higher doses. The use of etanercept should be discouraged.
为了概述目前关于肿瘤坏死因子-α（TNF-α）抑制剂治疗化脓性汗腺炎（HS）的适应证外治疗的证据，我们在 MEDLINE、EMBASE 和 CENTRAL 中进行了系统检索。纳入了任何类型的关于使用英夫利昔单抗、依那西普和/或阿达木单抗治疗 HS 患者的原始文章。未应用语言限制。经过全文筛选，符合纳入标准并进行数据提取的有 65 项研究，共涉及 459 例患者。其中有 4 项随机对照试验（RCT），其余为病例系列或报告。仅对 RCT 进行方法学质量评估。根据病例报告中提取的疗效数据，英夫利昔单抗治疗的患者中有 82%、阿达木单抗治疗的患者中有 76%、依那西普治疗的患者中有 68%有中度至良好的反应。由于证据水平中等，只能提供弱推荐。如果常规治疗方案失败，TNF-α抑制剂的使用可以作为治疗复发性严重 HS 的一种有效补充。基于最令人鼓舞的疗效和费用数据，应优先选择英夫利昔单抗。当使用更高剂量时，阿达木单抗似乎也很有前途。应避免使用依那西普。
