Quantifying Treatment Burden in Hidradenitis Suppurativa: A Cohort Study

To the Editor,

Hidradenitis suppurativa (HS) is a chronic skin condition characterized by recurrent and painful inflammatory lesions in intertriginous areas. ¹ Medical treatment of HS includes biologics, antibiotics, oral immunomodulators, hormonal therapies, topical therapies, and analgesics. ¹ Due to the recurrent and refractory course of HS, medication numbers and switch rates may be high,^2,3 contributing to the treatment burden on HS patients. Additionally, HS management often involves antibiotics prescribed in short-term courses.^4,5 The number of medications used by HS patients and the duration of medication use can impact clinical outcomes and treatment burden in HS patients. In this study, we aimed to quantify (1) the number of medications tried in HS patients and (2) medication persistence of HS treatments.

In this cohort study, we used the Merative MarketScan Commercial Claims and Encounters database to obtain medical and pharmaceutical claims data from patients with commercial insurance from January 1, 2018, to December 31, 2021, a total of 4 years. Included patients were ≥12 years old with a diagnosis of HS. Medication number was defined as the total number of unique HS medications (identified by National Drug Codes) tried per patient over the 4-year study period. Medication persistence was defined as the duration of continuous use of a medication over the course of a year, in number of days, with a permissible gap of ≤30 days between the end-of-supply date of a medication and the next dispensed date.

There were 36,801 HS patients included in the analysis. During the 4-year study period, 26.8% of patients tried 1 HS medication; 23.9% tried 2; 15.0% tried 3; and 34.3% tried 4 or more (Supplemental Table 1). The most common medications used in HS patients were non-opioid analgesics (11.1%, N = 46,603/418,309), topical antibiotics (10.2%, N = 42,843/418,309), and tetracycline antibiotics (9.7%, N = 40,405/418,309). These medications had a median medication persistence of 15, 30, and 30 days, respectively. Antibiotics, both topical and oral, were the most frequently used class of medications, comprising 41.1% (N = 172,060/418,309) of prescriptions and median medication persistence ranging from 5 to 30 days. Medications with the highest median medication persistence were biologics (112 days) and oral immunomodulators (95 days). However, they accounted for only 2.1% (N = 8839/418,309) and 0.4% (N = 1616/418,309) of prescriptions, respectively. Results are shown in Supplemental Figure 1.

Overall, HS patients are prescribed multiple medications for their condition, and there is a lack of long-term use of each medication. As HS treatments continue to evolve, this study highlights the need for broader use of effective and long-term maintenance treatments, such as biologics and systemic immunomodulators. Limitations of this study include the lack of HS severity information available on MarketScan and inclusion of only commercially insured patients. For chronic and debilitating skin conditions like HS, it is crucial to minimize treatment burden by maximizing safe, effective, and continuous therapies.