Hidradenitis suppurativa (HS) Learning Zone
Transcript: European guideline updates
Dr Thrasyvoulos Tzellos
Interview recorded Sep 2024. All transcripts are created from interview footage and directly reflect the content of the interview at the time. The content is that of the speaker and is not adjusted by Medthority.
First of all, in this Congress, in this EADV Congress, it was the first time that they recently accepted and soon-to-be-published European guidelines, new European guidelines were presented. And actually, we have many important new points. First of all, it was assessed through an evidence-based analysis and also with a full consensus that both adalimumab and bimekizumab and secukinumab should be considered as first-line treatment after failure of one correct round of antibiotic use.
But shall we use adalimumab to all our patients, or shall we use bimekizumab to all our patients? So the guidelines have a critical point regarding this as well. So we do know that when fistulas are present, the effect of adalimumab becomes much more lower. So the odds ratio to achieve significant clinical effect becomes much lower with adalimumab when fistulas are present. So it is easy to hypothesise that when we have a patient only with nodules and abscesses, yes, it makes sense to start with adalimumab since it is also cheaper. But we do have evidence that interleukin-17 inhibitors have a higher effect against draining tunnels, evidence that have been shown also in this EADV Congress. So it makes sense that when we have already presence of draining tunnels, of draining fistulas, to go over adalimumab use and start directly with interleukin-17 inhibition, either secukinumab or bimekizumab. Furthermore, it was suggested that in order to assess severity, in order to assess a non-mild disease, it is better to use the validated outcome of IHS4 mild, moderate, and severe because it serves the window of opportunity treatment much more than Hurley staging. And also it was suggested to use IHS4 55% reduction to assess treatment effect. And furthermore, it was suggested that when it comes to antibiotics, tetracycline should be considered as the first-line treatment in the right manner of use for 12 to 16 weeks. And practically, clindamycin and rifampicin seems to have the same effect with tetracycline.
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