Decisions on Biologic Switching and Therapeutic Drug Monitoring for Hidradenitis Suppurativa

In a detailed discussion, Dr. Alex Cerro presents strategies for selecting and switching biologic treatments for patients with Hidradenitis Suppurativa (HS), emphasizing the importance of individualized care due to the lack of head-to-head trials among existing FDA-approved therapies: adalimumab, secukinumab, and vimikizumab. He highlights the significance of recognizing loss of response to treatments, discussing common reasons such as disease progression, the need for higher dosages, or development of antibodies against the medications. Dr. Cerro advocates for therapeutic drug monitoring to assess drug levels and guide decisions on increasing doses or switching therapies when necessary. He underscores the urgency of considering patient comorbidities, treatment speed preferences, and insurance coverage in choosing treatments. Two case studies illustrate the practical application of these concepts; one involved a patient successfully escalated on adalimumab after demonstrating low drug levels, while another case described the switch to a JAK inhibitor after the patient developed antibodies to their TNF inhibitor. Dr. Cerro encourages proactive management, including potential off-label use of existing therapies where justified, while addressing the systemic barriers posed by insurance prior authorization processes. He concludes by noting ongoing developments in HS treatments and urges the importance of comprehensive patient evaluation to optimize care.