Therapeutic Drug Monitoring in Hidradenitis Suppurativa Patients With Suboptimal Treatment Response to Adalimumab

Adalimumab is a biologic used in the treatment of hidradenitis suppurativa (HS). Therapeutic drug monitoring (TDM) has emerged as a potential strategy to optimize treatment efficacy, yet its utility in HS remains underexplored. Our aim was to assess the utility of TDM in HS patients with suboptimal adalimumab response by investigating the prevalence of antidrug antibodies and subtherapeutic drug levels.

A cross-sectional study of 62 patients with suboptimal response to adalimumab was conducted at a dermatology clinic in Toronto, Ontario. Data on adalimumab serum trough levels, autoantibody status, and demographics were collected. Patients were divided into therapeutic (≥10.6 μg/mL) and subtherapeutic (<10.6 μg/mL) drug categories based on trough level.

Of 51 patients on adalimumab 40 mg weekly, 32 patients (62.7%) had therapeutic drug levels and 19 (37.3%) had subtherapeutic levels. In the 11 patients on adalimumab 80 mg weekly, 7 patients had therapeutic drug levels (28.19 μg/mL) and 4 had subtherapeutic levels (mean 3.26 μg/mL). Autoantibodies were detected in 21.06% of patients with subtherapeutic drug levels on adalimumab 40 mg weekly. There was a significant association between Hurley stage and drug level (P = .015) in patients on adalimumab 40 mg weekly.

In HS patients with suboptimal response to standard adalimumab dosing, a significant number of patients have subtherapeutic drug levels with a minority of those having anti-adalimumab antibodies. TDM can be helpful in identifying HS patients with subtherapeutic drug levels and without antidrug antibodies who could potentially benefit from dose escalation.