Biologic Treatment for Hidradenitis Suppurativa

Kelsey S. Flood; Martina L. Porter; Alexa B. Kimball


Am J Clin Dermatol. 2019;20(5):625-638. 

In This Article

Other Biologics


Efalizumab, a biologic that inhibits lymphocyte function-associated antigen 1 (LFA-1), was studied in a small cohort of five patients, in which clinical benefit was not observed in any patients and two patients had worsening of their disease.[125,126] After four cases of progressive multifocal leukoencephalopathy (PML) associated with efalizumab were reported, this drug was voluntary withdrawn from the market in 2009[41,43,127] (Table 2).


Some authors hypothesize that complement may be involved in recruiting neutrophils to active sites of HS. C5a and components of the membrane attack complex (C5b-9) are elevated in plasma samples from patients with HS as compared with healthy controls. Levels of complement were low in pus sampled from HS patients. Interestingly, plasma complement concentration was higher in Hurley stage I patients compared with patients who were stages II and III, suggesting complement activation may be an early event in HS pathogenesis.[128] IFX-1 is a monoclonal antibody that binds C5a, a component of the complement cascade.[128,129] One phase II clinical trial on IFX-1 has been completed.[130] The results have not been published in an academic journal. The company's website reports the results of a study completed in 12 patients who received nine doses of intravenous IFX-1. On day 134, 83% of patients had achieved HiSCR.[131] A phase II trial, studying four intravenous doses of IFX-1 compared with placebo, is currently ongoing but not recruiting[129] (Table 3).


CFZ533 is a monoclonal antibody with activity against CD40.[132] CD40 is found on antigen presenting cells and B cells, among other cell types. The binding of CD40 to its ligand, CD40L, can activate multiple immune processes.[132,133] Interestingly, patients with PASH have increased expression of CD40 and CD40 ligand (CD40L) in skin biopsies of pyoderma gangrenosum compared with controls. However, the authors did not specifically biopsy sites of HS. This observation led the authors to conclude that the CD40/CD40L system may contribute to the inflammation observed in PASH.[134] CFZ533 is currently being studied in a phase II platform clinical trial[135] (Table 3).