4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
Department of Computer Science and Biomedical Informatics, University of Thessaly, Lamia, Greece.
Dermatology. 2021;237(3):372-377. doi: 10.1159/000512617. Epub 2021 Jan 5.
Several patients with hidradenitis suppurativa (HS) present flare-ups during treatment with adalimumab (ADA), the cause of which is not clear. ADA is the only FDA-approved biologic for the therapy of moderate-to-severe HS. A previous study of our group has shown that Staphylococcus aureus stimulation of whole blood affects the production of human β-defensin 2 and modulates HS severity. It is, therefore, hypothesized, that carriage of S. aureus may drive HS flare-ups.
To explore the association between carriage of S. aureus and loss of response to ADA.
Among patients with moderate-to-severe HS without carriage of S. aureus at start of treatment with ADA, we investigated for carriage of S. aureus from the nares when flare-ups occurred. Flare-ups were pre-defined as at least 25% increase of inflammatory lesions (sum of inflammatory nodules and abscesses) from baseline. Samplings were also done after completion of 12 weeks of ADA treatment from all patients who did not present flare-ups. Clinical response to ADA was assessed by the HS Clinical Response score (HiSCR).
Thirty-nine patients were studied; 24 with Hurley II stage HS and 15 with Hurley III stage HS. Twenty-nine patients achieved HiSCR after 12 weeks of treatment without any flare-ups; 10 patients had flare-ups and failed HiSCR. Three (10.3%) and 5 (50%) patients, respectively, had nasal carriage of S. aureus (odds ratio 8.67; 95% CI 1.54-48.49; p = 0.014). Among 32 patients reaching follow-up week 48, 20 patients achieved HiSCR and 12 had flare-ups leading to ADA failure; 2 (10%) and 5 (41.7%) patients, respectively, had positive culture for S. aureus (odds ratio 6.42; 95% CI 1.00-41.20; p = 0.05).
Nasal carriage of S. aureus may be associated with loss of response to ADA. Findings need confirmation in larger series of patients.
一些患有化脓性汗腺炎 (HS) 的患者在接受阿达木单抗 (ADA) 治疗时会出现病情加重，其原因尚不清楚。ADA 是唯一获得 FDA 批准用于治疗中重度 HS 的生物制剂。我们之前的研究表明，金黄色葡萄球菌对全血的刺激会影响人β防御素 2 的产生，并调节 HS 的严重程度。因此，有人假设金黄色葡萄球菌的携带可能会导致 HS 病情加重。
探讨金黄色葡萄球菌携带与 ADA 治疗应答丧失之间的关系。
在开始接受 ADA 治疗时未携带金黄色葡萄球菌且患有中重度 HS 的患者中，我们在出现病情加重时调查了鼻内金黄色葡萄球菌的携带情况。病情加重定义为从基线开始炎症性病变（炎性结节和脓肿的总和）至少增加 25%。所有未出现病情加重的患者在接受 ADA 治疗 12 周后也进行了采样。ADA 治疗的临床应答通过化脓性汗腺炎临床应答评分（HiSCR）进行评估。
共研究了 39 名患者；24 名患者为 Hurley II 期 HS，15 名患者为 Hurley III 期 HS。29 名患者在接受 12 周治疗后达到 HiSCR，无任何病情加重；10 名患者出现病情加重，未能达到 HiSCR。分别有 3（10.3%）和 5（50%）名患者的鼻腔携带金黄色葡萄球菌（比值比 8.67；95%CI 1.54-48.49；p = 0.014）。在 32 名达到随访第 48 周的患者中，20 名达到 HiSCR，12 名出现病情加重导致 ADA 治疗失败；分别有 2（10%）和 5（41.7%）名患者的金黄色葡萄球菌培养阳性（比值比 6.42；95%CI 1.00-41.20；p = 0.05）。
鼻腔金黄色葡萄球菌的携带可能与 ADA 治疗应答丧失有关。这些发现需要在更大的患者系列中得到证实。
