Shih Terri, De Devea, Daveluy Steven D, Hogeling Marcia, Lowes Michelle A, Sayed Christopher, Shi Vivian Y, Hsiao Jennifer L
David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
Am J Clin Dermatol. 2022 Nov;23(6):749-753. doi: 10.1007/s40257-022-00711-1. Epub 2022 Aug 5.
Hidradenitis suppurativa (HS) is a chronic, progressive inflammatory skin disease that is often recalcitrant to multiple treatments. In determining biologic candidacy for patients with HS, we propose a paradigm shift away from Hurley staging and towards consideration of other variables. Biologics represent a long-term treatment option for HS that may serve as a disease-modifying agent. These medications are typically initiated in patients with moderate to severe disease, which, based on inclusion criteria in clinical trials, is often defined as Hurley stage II or III disease, at which point irreversible tissue damage has already occurred. In real-world clinical settings, these considerations include treatments tried and failed, predicted disease trajectory, disease characteristics beyond lesion type, impact of disease on patients' functional status and quality of life, and patient comorbidities, venturing away from the limitations of Hurley stage designations. Future clinical trials may benefit from inclusion of recalcitrant Hurley stage I patients, which may then re-shape treatment guidelines and insurance coverage and improve patient access to biologic treatments.
化脓性汗腺炎（HS）是一种慢性、进行性炎症性皮肤病，通常对多种治疗方法都具有顽固性。在确定HS患者的生物制剂治疗候选资格时，我们建议从赫尔利分期转向考虑其他变量，这是一种范式转变。生物制剂是HS的一种长期治疗选择，可能作为一种疾病改善药物。这些药物通常用于中重度疾病患者，根据临床试验的纳入标准，中重度疾病通常定义为赫尔利II期或III期疾病，此时已经发生了不可逆的组织损伤。在现实世界的临床环境中，这些考虑因素包括尝试过但失败的治疗方法、预测的疾病轨迹、病变类型以外的疾病特征、疾病对患者功能状态和生活质量的影响以及患者的合并症，突破了赫尔利分期指定的局限性。未来的临床试验可能会受益于纳入顽固性赫尔利I期患者，这可能会重塑治疗指南和保险覆盖范围，并改善患者获得生物制剂治疗的机会。
