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

Table 3

Study outcomes.

Authors	Measure	Combined cohort	Surgical cohort	Biologic cohort	value
(i) Adalimumab
(a) HS symptom improvement
Aarts et al. [9]	DLQI mean change	−8.2 ± 6.2	—	−4 ± 7.7	0.02
	∆HS-PGA ≥2 points	18/31 (58%)	—	4/31 (18%)	<0.001
	HiSCR % achieved	59%	—	38%	0.22
	∆IHS4, mean ± SD	−19.1 ± 11.3	—	−7.8 ± 11.8	<0.001
Bechara et al. [10]	hs-CRP	−2.32	−0.56	—	0.464
	DLQI	−5.4	−3.1	—	0.01
	HS-PGA-SP	−1.9	−0.9	—	0.011
	HSIA overall	−1.87	−1.05	—	0.014
	HSSA	−2.35	−1.62	—	0.057
Authors	Comparison	Site infections	Wound dehiscence	Bleeding emergencies	Other complications
(b) Adverse effects following surgery
Aarts et al. [9]	CTC vs BOC	No increased risk (12% vs 12%)	—	—	Total adverse events: 68% vs. 94% (p = 0.001) Acute HS flare: 22% vs. 34%
Bechara et al. [10]	CTC vs SOC	No increased risk	—	No increased risk	No increased risk
Authors	Measure	Combined cohort	Surgical cohort	Biologic cohort	value
(ii) Adalimumab, infliximab
(a) HS recurrence
Prens et al. [12]	Rate^a	0%	23.70%	—	—
Authors	Measure	Combined cohort	Surgical cohort	Biologic cohort	value
(b) Time to complete wound healing
Prens et al. [12]	Days to complete healing^b	185 days	67.9 days	—	<0.0001
Worden et al. [16]	CTC vs SOC: biologic used within 2 weeks before surgery (OR (95% CI))^c	0.23 (0.08–0.64)	—	—	0.005
	CTC vs SOC: biologic held >2 weeks before surgery (OR (95% CI))^c	1.99 (0.79–5.01)	—	—	0.146
Authors	Comparison	Site infections	Wound dehiscence	Bleeding emergencies	Other complications
(c) Adverse effects following surgery
Prens et al. [12]	CTC vs SOC	No increased risk	—	—	—
Worden et al. [16]	CTC vs SOC	—	—	—	—
(iii) Adalimumab, infliximab, ustekinumab
(a) HS symptom improvement
Shanmugam et al. [14]	HSS (decrease in points)	−27	−2	—	0.013
	Reduction in AN units	0.9	0.1	—	0.033
Authors	Measure	Combined cohort	Surgical cohort	Biologic cohort	value
(b) HS recurrence
Salvador-Rodriguez et al. [13]	Rate^d	9.52%	26.31%	—	0.1
Authors	Measure	Combined cohort	Surgical cohort	Biologic cohort	value
(c) Time to complete wound healing
Salvador-Rodriguez et al. [13]	Days to complete healing^e	70.28 days	57.68 days	—	<0.01
	CTC vs SOC (β(SD))^f	6.33 (1.73)	—	—	<0.01
Authors	Comparison	Site infections	Wound dehiscence	Bleeding emergencies	Other complications
(d) Adverse effects following surgery
Salvador-Rodriguez et al. [13]	CTC vs SOC^e	4.76% vs 0%,	—	19.05% vs 2.63% ()	—
	CTC vs SOC (β(SD))^f	—	—	0.78 [0.67] ()	—
Shanmugam et al. [14]	CTC vs SOC	—	—	—	—
	CTC vs BOC	—	—	—	—
Authors	Measure	Combined cohort	Surgical cohort	Biologic cohort	value
(iv) Infliximab, ustekinumab
(a) HS recurrence
DeFazio et al. [11]	Sites affected	19%	38.50%	—	<0.01
	Mean time	18.5 months	6 months	—	<0.001
Authors	Measure	Combined cohort	Surgical cohort	Biologic cohort	value
(b) New HS lesions
DeFazio et al. [11]	Patients affected	18%	50%	—	<0.001
	Mean time	18 months	8.5 months	—	<0.05
Authors	Comparison	Site infections	Wound dehiscence	Bleeding emergencies	Other complications
(c) Adverse effects following surgery
DeFazio et al. [11]	CTC vs SOC	No significant difference	No significant difference	—	—
Authors	Measure	Combined cohort	Surgical cohort	Biologic cohort	value
(v) Infliximab
(a) HS symptom improvement
Van Rappard and Mekkes [15]	PGA	3.3	—	2.8	<0.001
Authors	Comparison	Site infections	Wound dehiscence	Bleeding emergencies	Other complications
(b) Adverse effects following surgery
Van Rappard and Mekkes [15]	CTC vs BOC	—	—	—	Not observed

^aIn 12-month follow-up duration. ^bReported data available from 4 out of 5 patients. ^cMultivariate logistic regression was used to predict poor healing of involved sites. ^dRate at 24 weeks. ^eUnivariate analysis. ^fMultivariate logistic regression analysis was used to identify confounding variables associated with bleeding emergencies and time to complete wound healing. AN, active nodule; AN75, 75% reduction in active nodule count; BOC, biologic-only cohort; CI, confidence interval; CTC, combined treatment cohort; DLQI, Dermatology Life Quality Index; HiSCR, Hidradenitis Suppurativa Clinical Response; hs-CRP, high-sensitivity C-reactive protein; HS-PGA-SP, HS patient’s global assessment of skin pain; HS, hidradenitis suppurativa; HSIA, HS Impact Assessment; HSS, Hidradenitis Suppurativa Sartorius Score; HSSA, HS symptom assessment; IHS4, International Hidradenitis Suppurativa Severity Score System; OR, odds ratio; , value; PGA, Physician Global Assessment; SD, standard deviation; SOC, surgery-only cohort; %, percent; β, beta coefficient; ∆, difference.