Outcomes Following Combined Radical Resection and Targeted Biologic Therapy for the Management of Recalcitrant Hidradenitis Suppurativa
James Economides, MD, Michael DeFazio, MD, Kevin Han, MD, Kathryn King, BS, Karen K. Evans, MD.
Georgetown University Hospital, Washington, DC, USA.
PURPOSE: Trials demonstrating the efficacy of biologic therapy for severe hidradenitis suppurativa (HS) have paved the way for new multidisciplinary treatment strategies.
METHODS: Between 2011 and 2014, 21 patients with 57 cases of recalcitrant (Hurley Stage III) HS underwent either radical resection with delayed primary closure alone, or in combination with targeted biologic therapy. Demographics, treatment regimen, outcomes, and complication rates were retrospectively reviewed.
RESULTS: Eleven patients underwent combined surgical and biologic therapy, whereas radical resection alone was performed in the remaining 10 patients. The average wound for patients in the combined and surgical cohorts was 56.3 cm2 and 48.5 cm2, respectively (p>0.05). Biologic agents were initiated two weeks following closure and continued for an average of 10.5 months (r, 6-15 months). Recurrence in the combined cohort was noted in 4 of 29 sites (18.8%) compared with 10 of 26 sites (38.5%) for patients in the surgery alone cohort (p<0.01). For those in the combined cohort, the mean disease-free interval was approximately one year longer (18.5 versus 6 months; p<0.05); however, this difference was reduced to 4.5 months when time to recurrence following cessation of biologic therapy was considered (p>0.05). New disease developed in 2 (18.2%) and 5 (50%) patients in the combined and surgical cohorts, respectively (p<0.05). No adverse events were noted among patients who received biologic therapy.
CONCLUSIONS: Lower rates of recurrence and disease progression, as well as a longer disease-free interval may be achieved with the use of adjuvant biologic therapy following radical resection for recalcitrant HS.
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