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Summary   Background  Weekly adalimumab (Humira ® ) is approved for the treatment of hidradenitis suppurativa ( HS ) based on the 12‐week placebo‐controlled periods of the two phase  III PIONEER  trials.    Objectives  Using  PIONEER  integrated trial results, we aimed to evaluate the optimal medium‐term adalimumab maintenance dosing strategy for moderate‐to‐severe  HS .    Methods  Each trial had two double‐blind periods; 12‐week Period A and 24‐week Period B. Patients randomized to adalimumab 40 mg every week ( ADA ew) (Period A), were rerandomized in Period B to  ADA ew ( ADA ew/ew),  ADA  every other week ( ADA ew/eow), or placebo ( ADA ew/pbo). Placebo‐randomized patients were reassigned in Period B to  ADA ew ( PIONEER  I) or placebo ( PIONEER II ). The primary outcome was  HS  Clinical Response (Hi SCR ). Patients who lost response during Period B were discontinued from the study and offered an option to enter the open‐label extension ( OLE ) to receive  ADA ew. Results are reported across the two study periods, and data were combined from the two study periods and the  OLE .    Results  For week‐12 Hi SCR  achievers, the Hi SCR  week‐36 rate was 48·1% ( ADA ew/ew) vs. 46·2% ( ADA ew/eow) and 32·1% ( ADA ew/pbo). Combining (post hoc) these patients with week‐12 partial responders further differentiated outcomes in Period B ( ADA ew/ew 55·7% vs.  ADA ew/eow 40·0% and  ADA ew/pbo 30·1%). Period‐B adverse‐event rates were  ADA ew/ew 59·6% vs.  ADA ew/eow 57·4% and  ADA ew/pbo 65·0%. One patient ( ADA ew/ew) reported a serious infection.    Conclusions  Weekly adalimumab treatment, effective throughout 36 weeks, was the optimal maintenance medium‐term dosing regimen for this population. At least partial response after 12 weeks with continued weekly dosing had better outcomes than dose reduction or interruption. Patients who do not show at least a partial response to weekly adalimumab by week 12 are unlikely to benefit from continued therapy. No new safety risks were identified.What's already known about this topic?Hidradenitis suppurativa (HS) is a chronic inflammatory disease, commonly misinterpreted as an infection and treated with long‐term antibiotic regimens or surgical incisions.  Based on the chronicity of HS and the lack of evidence for efficacious and safe long‐term HS treatments, it is important to evaluate medium‐ to long‐term therapies for HS.  Weekly adalimumab (Humira ® ) is approved for the treatment of moderate‐to‐severe HS based on the two phase III PIONEER trials.What does this study add?This study pooled data from the two PIONEER trials, providing a more robust assessment of outcomes.  After at least partial treatment success with weekly adalimumab short‐term therapy (12 weeks), continuing weekly dosing during the subsequent 24 weeks had better outcomes than dose reduction or treatment interruption.  Patients who do not show at least a partial response to weekly adalimumab by week 12 are unlikely to benefit from continued therapy.

british journal of dermatology

Adalimumab medium‐term dosing strategy in moderate‐to‐severe hidradenitis suppurativa: integrated results from the phase  III  randomized placebo‐controlled  PIONEER  trials