Decisions on Biologic Switching and Therapeutic Drug Monitoring for HS

The presentation focused on biologic treatments and therapeutic drug monitoring for patients with hidradenitis suppurativa (HS). It opened with a case study of a biologic-naive patient with stage 3 HS and breast cancer, discussing treatment options including the FDA-approved biologics adalimumab and secukinumab. The speaker emphasized the importance of individualizing biologic therapy based on patient characteristics, history of therapies, and the pharmacokinetic profiles of medications. Common reasons for treatment failure include disease mechanisms, rapid clearance, and immune-mediated reactions such as antibody formation. Therapeutic drug monitoring is essential to understand why a treatment may cease to be effective, prompting evaluations of medication levels and antibody presence. The discussion highlighted that levels required for effective treatment in HS may differ from other inflammatory diseases, with higher thresholds needed for optimal response. Switching between biologics or adjusting dosing can be necessary for patients who lose therapeutic response. A second case illustrated the possibility of increasing the dose of adalimumab for an initial responder who lost efficacy. The speaker then discussed strategies for rescuing medications that patients need to persist on due to other comorbidities. The presentation also touched on insurance complications and the benefits of recognizing comorbid conditions to facilitate drug approval. It concluded by encouraging the use of resources for prior authorization to aid in treatment accessibility.