Combined Biologic and Surgical Interventions for Hidradenitis Suppurativa: A Systematic Review

Table 1

Included studies.

Authors	Biologic used (no. of patients)	Biologic regimen	Type of surgery	Study type	Country of study/year	Level of evidence^m	GRADE quality^n
Aarts et al. [9]	Adalimumab (n = 62)	12-month treatment course	Wide excision, limited excision, and deroofing with secondary intention healing	Pragmatic randomized control trial^j	Netherlands/2023	Ib	High
Bechara et al. [10]	Adalimumab (n = 103)	24-week treatment course	Wide excision^c with secondary intention healing	Randomized controlled trial^k	Canada, Czechia, Colombia, Spain, Germany, France, Italy, United Kingdom, United States, Turkey, Greece, Belgium, Netherlands, Romania, Mexico, Russia, Denmark, Portugal, Poland, and Norway/2021	Ib	High
DeFazio et al. [11]	Infliximab (n=8)	Average initiation on postoperative Day 16^b	Radical resection^d with delayed primary closure^e,f	Retrospective cohort	United States/2016	2b	Moderate
	Ustekinumab (n = 3)
Prens et al. [12]	Adalimumab (n = 4)	Postoperatively held for 1 week	Major surgery (not specified)	Prospective cohort	Netherlands/2019	2b	Moderate
	Infliximab (n = 1)	Postoperatively held for 2 weeks
Salvador-Rodriguez et al. [13]	Adalimumab (n = 17)	Completed ≥16 weeks preoperatively	Excision with secondary intention healing	Prospective cohort	Spain/2020	2b	Moderate
	Infliximab (n=2)
	Ustekinumab (n=2)
Shanmugam et al. [14]	Adalimumab (unspecified)	Not specified	Not specified	Prospective cohort^l	United States/2018	2b	Moderate
	Infliximab (unspecified)
	Ustekinumab^a (unspecified)
Van Rappard and Mekkes [15]	Infliximab (n=30)	Not specified	Deroofing procedures and small to large excisions with secondary intention healing, primary closure, or grafting procedures	Retrospective cohort	Netherlands/2012	2b	Moderate
Worden et al. [16]	Adalimumab (unspecified)	Preoperatively held for >2 weeks	Incision^g, excision^h, and excision with repair^i	Retrospective cohort	United States/2020	2b	Moderate

^aUstekinumab was chosen due to the presence of one or more autoantibodies, a history of drug reaction from tumor necrosis factor-alpha (TNF-a) inhibitor, or coexistent psoriasis. ^bFour patients remained on biologic treatment at the time of follow-up. ^cComplete excision of lesions with more than 50% but leaving parts of the anatomic area. ^dExcision of all hair-bearing skin within an affected region, including a clear margin of 1 centimeter. ^eAll patients underwent serial debridement before definitive closure. ^fDelayed primary closure with nondissolvable vertical mattress sutures. ^gIncision and drainage with fulguration of cavities and sinus tracts with electrocautery. ^hExcision of an involved area with the wound left open to drain. ⁱRepair included excision of involved areas followed by direct defect closure, skin graft, or skin flap. ^jNCT03221621. ^kNCT02808975. ^lEligible patients determined from Wound Etiology and Healing (WE-HEAL) cohort (IRB 041408, NCT01352078). ^m2009 Oxford Center for Evidence-Based Medicine: Levels of Evidence. ⁿGRADE method (Grading of Recommendations, Assessment, Development, and Evaluation) used to assess quality of evidence regarding overall hidradenitis suppurativa symptom improvement.