Title: Effectiveness of Upadacitinib for Paradoxical Psoriasis in Hidradenitis Suppurativa: A Multicenter Ambispective Study.
Description
Background: Paradoxical psoriasis (PP) is the most frequent paradoxical reaction to biologic therapy in hidradenitis suppurativa (HS), most commonly induced by TNF inhibitors. Despite its frequency, robust evidence on the treatment of PP in this setting is lacking. Objective: to evaluate the effectiveness of upadacitinib for biologics induced-PP in patients with HS. Methods: We conducted a multicenter ambispective study across twelve Spanish centers including 30 patients with HS who developed PP and were then treated with upadacitinib. The primary outcome was change in PP severity (Physician's Global Assessment, PGA); secondary outcomes included Psoriasis Area and Severity Index (PASI), HS activity (IHS4), quality of life (DLQI), safety, and predictors of response. Results: PGA decreased from a median of 3 to 1 (median difference, 2.5; p<.001), with 23 patients (76.7%) presenting clinical response. PASI improved in 20/24 evaluable patients (83.3%; p<.001). IHS4 fell from 13 to 5 (p<.001), with clinical response in 22 of 25 patients (88.0%), and DLQI improvement (p=.002). Younger age and lower baseline disease burden were associated with response in exploratory analyses. Limitations: Limited n for predictions. Conclusions: Upadacitinib was associated with simultaneous improvement of both PP and HS, with an acceptable safety profile. Prospective controlled studies are warranted.
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Institutions
- Hospital General de GranollersCatalonia, Barcelona