Intravenous Golimumab After Infliximab Failure in Hidradenitis Suppurativa: A Retrospective Cohort Study
Description
Infliximab (IFX), a chimeric anti–TNF-α antibody, is a weight-based therapy for hidradenitis suppurativa (HS) but is contraindicated after IFX-associated anaphylaxis (IAAx) or anti-IFX antibody formation (IAAb). In this setting, intravenous golimumab (IVgol), a human IFX congener, has been proposed for refractory HS. A retrospective cohort study was conducted on 30 HS patients treated with IVgol ≥1 month following IAAx/IAAb. Outcomes included HS-physician global assessment (HS-PGA), numerical rating scale for pain (NRS-pain), and inflammatory markers (c-reactive protein [CRP], erythrocyte sedimentation rate [ESR], interleukin-6 [IL-6], and white blood cell count [WBC]). Wilcoxon signed-rank test and linear mixed-effects models suggested that IVgol treatment was associated with significant improvements in HS-PGA, NRS-pain, and inflammatory marker levels following IVgol therapy, supporting consideration of IVgol as an alternative weight-based therapy after IFX discontinuation due to IAAxor IAAb. Recognizing that some patients were well-controlled on IFX at the time of transition, we evaluated outcomes separately by baseline disease severity. The number of evaluable patients decreased over time due to missing data, variable follow-up, and rolling initiation of IVgol. Figure S1: Change in HS-PGA from Baseline Among Patients with Moderate-to-Severe Hidradenitis Suppurativa at Months 1, 6, and 12. The moderate-to-severe group intended to capture patients who deteriorated during the transition from IFX to IVgol, most commonly due to lapses in therapy and/or prolonged delays due to insurance denials. Figure S1 shows the progression of HS-PGA among the 23-patient cohort with moderate-to-severe HS treated with IVgol from baseline to months 1, 6, and 12. Colored bars represent the percentage of patients who improved ≥2 grades, improved 1 grade, remained unchanged, or worsened. Figure S2: Change in HS-PGA from Baseline Among Patients with Clear-to-Mild Hidradenitis Suppurativa at Months 1, 6, and 12. Figure S2 shows the progression of HS-PGA among the 7-patient cohort with clear-to-mild HS treated with intravenous IVgol from baseline to months 1, 6, and 12. Colored bars represent the percentage of patients who improved 1 grade, remained unchanged, or worsened. Additional exploratory analyses were conducted to assess differences in response according to BMI (obese [≥30 kg/m²] vs. non-obese [<30 kg/m²]) and reason for IFX discontinuation (IAAx vs. IAAb). Separate linear mixed-effects models included fixed effects for time, subgroup, and subgroup-by-time interaction terms to assess whether treatment response trajectories differed between groups. Obesity may be associated with attenuated early pain improvement and less favorable WBC trajectories, while patients transitioned after IAAx appeared to demonstrate less improvement in selected clinical outcomes than those transitioned after IAAb; findings should be interpreted cautiously given the small subgroup sizes.
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Institutions
- Weill Cornell MedicineNew York, New York