Efficacy of Infliximab treatment in patients with severe Fistulizing Hidradenitis Suppurativa

Background: The association of Crohn's disease with Fistulizing Hidradenitis Suppurativa (FHS) was established in the 90s. FHS is a chronic disease, characterized by the formation of multiple abscesses and sinus tracts in apocrine gland-bearing areas. The aetiology and pathogenesis is unknown. The disease is painful. and often socially disabling implying a poor Quality of Life. Treatment of FHS with Infliximab - a chimeric antibody to TNF alpha - has recently been proposed as alternative to surgery. Aim: To describe efficacy of Infliximab treatment in the first 2 Danish patients with resistant severe FHS. Methods: Two patients with severe FHS previously unsuccessfully treated with conventional therapies. Infliximab 5 mg/kg was given as induction treatment. Clinical response was measured by MRI and modified Quality of Life scoring before and after the Infliximab. Results: The first patient obtained partial remission after the first infusion, with 2 active sinus tracts of 20 detected by MRI. The patient became INF dependent and continued on maintenance treatment every 8th week. In total 8 infusions. The second patient obtained partial remission after 3 infusions and did not experience relapse after withdrawal of Infliximab. The clinical findings of remission were underscored by showing improvement on MRI. The Quality of Life has been increased in both patients. Conclusion: Infliximab treatment seems to be efficacious in patients with severe FHS. Maintenance treatment may be necessary. Infliximab can lead to improvement in Quality of Life, partial remission of disease verified by closure of fistula in MRI and keeping the patients from mutilating surgery. (c) 2008 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.