Interventions for hidradenitis suppurativa: a Cochrane systematic review incorporating GRADE assessment of evidence quality

Br J Dermatol. 2016 Jan 23. doi: 10.1111/bjd.14418. [Epub ahead of print]

Interventions for hidradenitis suppurativa: a Cochrane systematic review incorporating GRADE assessment of evidence quality.

Ingram JR1, Woo PN2, Chua SL3, Ormerod AD4, Desai N5, Kai AC5, Hood K6, Burton T7, Kerdel F8, Garner SE9, Piguet V1.

Abstract

BACKGROUND:

More than 50 interventions have been used to treat hidradenitis suppurativa (HS) and so therapy decisions can be challenging.

OBJECTIVES:

To summarise and appraise randomised controlled trial (RCT) evidence for HS interventions in adults.

MATERIALS AND METHODS:

Searches were conducted in MEDLINE, EMBASE, CENTRAL, LILACS, five trials registers and abstracts from eight dermatology conferences until 13 August 2015. Two review authors independently assessed study eligibility, extracted data and assessed methodological quality. Primary outcomes were quality of life and adverse effects of the interventions.

RESULTS:

Twelve trials, from 1983 to 2015, investigating 15 different interventions met our inclusion criteria. Median trial duration was 16 weeks and the median number of participants was 27. Adalimumab 40mg weekly improved the Dermatology Life Quality Index by 4.0 points, which equates to the minimal clinically important difference for the scale, compared to placebo (95% confidence interval (CI) -6.5 to -1.5 points). Evidence quality was reduced to ‘moderate’ because results are based on only a single study. Adalimumab 40mg every other week was ineffective in a meta-analysis of two studies comprising 124 participants. Infliximab 5mg/kg improved DLQI score by 8.4 points after eight weeks in a moderate quality study completed by 33 of 38 participants. Etanercept 50mg twice weekly was ineffective. Inclusion of a gentamicin sponge prior to primary closure did not improve outcomes. Other interventions including topical and oral antibiotics, were investigated by relatively small studies, preventing treatment recommendations due to imprecision.

CONCLUSIONS:

More, larger RCTs are required to investigate most HS interventions, particularly oral treatments and surgical therapy. Moderate quality evidence suggests that adalimumab given weekly and infliximab are effective whereas adalimumab every other week is ineffective. This article is protected by copyright. All rights reserved.