P089 Efficacy of tofacitinib in cases of moderate-to-severe (stage 2 and stage 3) hidradenitis suppurativa: a pilot study

Abstract Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition characterized by nodules, abscesses and scarring in areas like the axillae, groin and inframammary folds. It significantly affects patients’ quality of life. Treatment options are limited, and existing therapies like adalimumab and secukinumab show inconsistent results. Tofacitinib, a Janus kinase inhibitor, has shown promise in case reports as a potential novel treatment for HS (Savage KT, Santillan MR, Flood KS et al. Tofacitinib shows benefit in conjunction with other therapies in recalcitrant hidradenitis suppurativa patients. JAAD Case Rep 2020; 6: 99–102; Sadeghzadeh Bazargan A, Pashaei A, Goodarzi A. Successful treatment of hidradenitis suppurativa with tofacitinib: two cases and a review of the literature. Oxf Med Case Rep 2023; 2023: omad003). However, there is limited literature on the effectiveness of tofacitinib in HS. This study aimed to evaluate its efficacy in patients with moderate-to-severe HS (Hurley stages 2 and 3) unresponsive to conventional therapies. A cohort of 29 patients with moderate-to-severe HS was enrolled. The patients received tofacitinib (5–10 mg twice daily) for 6 months, with regular clinical assessments. Treatment response was assessed at 6 months in terms of the proportion of patients achieving ≥ 55% reduction in the International HS Severity Score (IHS4). Secondary outcomes included sonographic evaluations using the SOS-HS system, changes in quality of life (Hidradenitis Suppurativa Quality of Life; HiSQOL), Hidradenitis Suppurativa Physician’s Global Assessment (HSPGA), maximal suppuration score and maximal pain score improvement, changes in interleukin-6 levels, and ≥ 50% improvement in Hidradenitis Suppurativa Clinical Response (HiSCR 50). Overall, 16 (55%) patients achieved ≥ 55% reduction in IHS4, with the median score decreasing from 22 at baseline to 9 at 6 months (P < 0.05). Sonographic evaluations revealed a shift towards milder disease stages, with fewer patients in stage 3 and with complex fistulas, along with significant reductions in vascularization (P = 0.002) and oedema (P = 0.007). However, fibrosis worsened slightly. Additionally, 21 (72%) patients achieved HiSCR 50. Clinically meaningful reductions in HiSQOL and HSPGA were observed in 13 (45%) and 9 (24%) patients, respectively. Interleukin-6 levels decreased from 8.7 to 6.3, although not significantly (P = 0.6). Six patients (28%) relapsed at 9 months. Adverse events were mild, including lipid abnormality and submandibular swelling, leading to temporary discontinuation of tofacitinib. In conclusion, tofacitinib showed significant potential in treating moderate-to-severe HS, improving disease severity, quality of life and associated inflammation. These promising findings highlight the need for more extensive trials with controls to confirm its safety and efficacy.