Anakinra showed the potential to be an effective and well-tolerated treatment for hidradenitis suppurativa (HS) in a randomized, placebo-controlled clinical trial of 20 participants with a 12-week treatment phase and a 12-week follow-up phase. Patients were randomized to receive injections containing placebo or anakinra subcutaneously once daily for 12 weeks. Researchers found:

• Disease activity was decreased at the end of treatment in 20% of the placebo arm compared with 67% of the anakinra arm.

• HS clinical response at 12 weeks was achieved in 30% of the placebo arm and in 78% of the anakinra arm.

• Production of interferon-y by peripheral blood mononuclear cells in the anakinra arm was decreased, and the production of interleukin-22 was increased.

• Time to a new HS exacerbation was prolonged in the anakinra arm.

• No serious adverse events were reported.

Citation: Tzanetakou V, Kanni T, Giatrakou S, et al. Safety and efficacy of anakinra in severe hidradenitis suppurativa: A randomized clinical trial. [Published online ahead of print November 18, 2015]. JAMA Dermatol. doi: 10.1001/jamadermatol.2015.3903.

Commentary: Our understanding of the inflammatory and immunopathologic nature of hidradenitis suppurativa (HS) has allowed for important studies of biologic-related therapy for this distressing, chronic disorder with significant quality of life issues. Studies on TNF-alpha antagonists (infliximab and adalimumab) have shown significant beneficial responses. In this small study of anakinra IL-1 inhibitor on 20 patients for 12 weeks of therapy with 12 weeks subsequent follow-up vs placebo, 67% of patients in the anakinra arm vs 20% in placebo showed significant impact in disease activity. Interesting immunological responses were also noted with a decrease in interferon alpha in the anakinra arm and an increase in IL-22. Anakinra has also been shown to be of value in palmar-plantar Pustular Psoriasis with an acceptable safety profile. — Alan Menter, MD