Stopping adalimumab before surgery is not necessary

Hidradenitis suppurativa (Syn. Acneinversa) is one of the most troublesome and complicated skin diseases. Adalimumab, an anti-inflammatory drug, may improve symptoms; however, patients often have to undergo surgery as well. Until now, it was not clear whether adalimumab should be discontinued before the procedure. A four-year, multi-center, global study coordinated by Professor Falk Bechara of the Dermatosurgery Department of the University Dermatology Clinic in Bochum (Director: Professor Eggert Stockfleth) came to the conclusion that discontinuation is not necessary. “This is an important step for patients with moderate and severe HS, who need to undergo surgery,” explains Falk Bechara. The results were published in the journal JAMA Surgery on August 18, 2021.

Not curable yet, but treated more effectively

Hidradenitis suppurativa is a chronic inflammatory disease caused by occlusion of the hair follicles. It often occurs under the arms, in the groin and in the genital area with serious embarrassment for patients. In advanced stages, the disease is extremely painful and also causes enormous mental distress and reduced quality of life. It is not yet curable, but the symptoms can be drastically improved by treatment options that have improved considerably in recent years. The Bochum Dermatosurgery Department, headed by Falk Bechara, is one of the main international centers, treating 1,000 patients per year. The study, which involved 45 centers in 20 countries, was coordinated here.

The study focused on adalimumab, a standard immunomodulatory anti-inflammatory drug that has been used successfully for years – not just for hidradenitis suppurativa. Areas of indication include severe psoriasis, but also rheumatic diseases and chronic inflammatory bowel diseases such as ulcerative colitis or Crohn’s disease. The efficacy and safety of adalimumab has been evaluated in several trials in the past. Until now, however, it was not clear whether it could be combined and continued during surgeries, which are often required for patients with HS. No data on this subject was available so far. The study included 200 patients, who received either the drug or a placebo.

Results to be evaluated for other diseases

The study shows that it is not necessary to stop adalimumab even after surgery for hidradenitis suppurativa. It is effective and safe both before and after surgery. “Further studies are needed to determine to what extent these positive study results can be transferred to other diseases that also require surgery, as Bechara points out:” The outlook is certainly very bright. . “

Falk Bechara, lead author of the study