Hidradenitis Suppurativa Clinic, Dermatology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain.
Instituto de Investigación Biosanitaria, Ibs Granada, Granada, Spain.
Dermatology. 2020;236(4):307-313. doi: 10.1159/000506074. Epub 2020 Mar 5.
BACKGROUND/AIMS: TNF-α inhibitors represent the most advanced approved therapeutic option for moderate and severe forms of hidradenitis suppurativa (HS). However, in recent years, cases of paradoxical HS secondary to the use of these biological drugs have been described, with very few cases reported in the literature. The aims of this study are (1) to present 2 new cases of paradoxical HS and (2) to perform a systematic review of scientific evidence regarding paradoxical HS with TNF-α inhibitors.
This is a retrospective study in which we searched all the cases of paradoxical HS secondary to the use of TNF-α inhibitors published in the literature and included two additional cases observed in our clinical practice.
A total of 34 patients under TNF-α inhibitor treatment were included (adalimumab = 21; infliximab = 9; etanercept = 4). The median delay from exposure to TNF-α inhibitor and the development of paradoxical HS was 12 months (range 1-72). The majority of patients were Hurley stage II (58.8%). Clinical improvement and complete remission were more frequent when the TNF-α inhibitor was stopped or switched to another biological agent with a different therapeutic target rather than maintenance or change to another TNF-α inhibitor.
Paradoxical HS is an unusual adverse effect of TNF-α inhibitors. When this adverse effect appears, interruption or substitution of treatment is associated with a better clinical outcome.
背景/目的：TNF-α 抑制剂是治疗中重度化脓性汗腺炎的最先进的获批治疗方法。然而，近年来，这些生物药物的使用引发了化脓性汗腺炎的矛盾反应，文献中仅报道了少数病例。本研究的目的是：（1）报告 2 例新的化脓性汗腺炎矛盾反应病例；（2）对 TNF-α 抑制剂引起化脓性汗腺炎矛盾反应的科学证据进行系统回顾。
这是一项回顾性研究，我们检索了所有文献中报道的 TNF-α 抑制剂引起化脓性汗腺炎矛盾反应的病例，并纳入了我们临床实践中观察到的另外 2 例病例。
共纳入 34 例接受 TNF-α 抑制剂治疗的患者（阿达木单抗=21 例；英夫利昔单抗=9 例；依那西普=4 例）。从暴露于 TNF-α 抑制剂到化脓性汗腺炎矛盾反应的发生的中位数时间为 12 个月（范围 1-72 个月）。大多数患者为 Hurley 分期 II 期（58.8%）。与维持治疗或改用另一种 TNF-α 抑制剂相比，停用 TNF-α 抑制剂或改用另一种作用机制不同的生物制剂治疗与更好的临床结局相关。
化脓性汗腺炎矛盾反应是 TNF-α 抑制剂的一种罕见不良反应。当出现这种不良反应时，中断或替代治疗与更好的临床结局相关。
