In a recent study published in JAMA Dermatology, researchers revealed a breakthrough treatment for recalcitrant hidradenitis suppurativa (HS) through the utilization of intravenous (IV) ertapenem therapy. HS is a chronic inflammatory disease affecting hair follicles, leading to recurrent or chronic inflammatory lesions in areas such as the axillae, groin, buttocks, and perineal regions. Its onset typically occurs after puberty, and a familial form affects 30% of patients, rendering HS a significant burden on quality of life. The disease’s impact is substantial compared to other chronic dermatological conditions such as acne, psoriasis, or atopic eczema.
The study, led by Nosrati et al., addresses the limitations of traditional oral antibiotic treatments for HS by exploring the efficacy of selective IV antibiotics, particularly ertapenem, which could offer more promising clinical outcomes. They aimed to investigate the optimal course duration, effectiveness, and patient satisfaction associated with IV ertapenem for HS.
Dr. Nosrati and colleagues conducted a retrospective review of medical records from 98 HS patients between 2018 and 2022. Patients’ outcomes were assessed before and after treatment, and a telephone survey was conducted to gauge patient satisfaction and perspectives. Patients self-administered 1g of ertapenem at home via a peripheral IV central catheter, utilizing an elastomeric pump for a duration of 12 to 16 weeks. Ongoing treatments with antiandrogens and immunomodulatory biologic therapies were continued concurrently with ertapenem administration.
Primary outcomes, including clinical severity measured through the HS Physician Global Assessment score and a numerical rating scale for pain, along with markers of inflammation, were evaluated at baseline, midcourse of treatment, end of the course, and post-therapy. Bacterial abundance was examined at these time points, with patient satisfaction being assessed during follow-up.
The study involved 98 patients, predominantly female (62.2%), with a mean age of 35.8 years. The mean treatment duration was 13.1 weeks, followed by a post-therapy follow-up at 7.8 weeks. Significant improvements were observed in HS Physician Global Assessment scores, pain scales, C-reactive protein, interleukin-6, and leukocytes. Nearly 78% of patients reported medium to high satisfaction, with 90.8% willing to recommend ertapenem to fellow HS patients. Similarly, Join-Lambert et al. also conducted a pilot study and found that ertapenem can significantly improve severe HS. However, consolidation treatments are necessary to further improve HS and prevent relapses.
The survey findings suggest that a 13-week course of IV ertapenem therapy contributes to notable increase in both clinical indicators and inflammatory markers, leading to improved patient satisfaction. However, caution is advised regarding the potential risk of antimicrobial resistance associated with prolonged treatment. These findings hold promise for the development of more efficacious and patient-centric interventions, ultimately augmenting the quality of life for those grappling with HS.
References
- Nosrati A, Ch’en PY, Torpey ME, Shokrian N, Ball G, Benesh G, et al. Efficacy and Durability of Intravenous Ertapenem Therapy for Recalcitrant Hidradenitis Suppurativa. JAMA Dermatology [Internet]. 2024 Feb 14 [cited 2024 Feb 16].
- Join-Lambert O, Coignard-Biehler H, Jais JP, Delage M, Guet-Revillet H, Poirée S, et al. Efficacy of ertapenem in severe hidradenitis suppurativa: a pilot study in a cohort of 30 consecutive patients. Journal of Antimicrobial Chemotherapy. 2016 Feb 1;71(2):513–20.