Predictors of adalimumab durability in hidradenitis suppurativa: a multicenter cohort study

BACKGROUND: Adalimumab is widely used for hidradenitis suppurativa (HS), but treatment durability varies and predictors of sustained benefit remain uncertain. OBJECTIVE: To identify clinical and laboratory factors associated with adalimumab treatment durability in HS. METHODS: We retrospectively studied 135 adults with HS who initiated adalimumab as first biologic therapy across three academic centers from 2013 to 2023. Outcomes were categorized as primary failure (12-24 weeks), secondary failure (24 weeks-2 years), or sustained response (>2 years) based on discontinuation for inefficacy. Predictors of treatment durability were evaluated using ordinal logistic regression. RESULTS: In univariable analyses, Hurley stage 3, higher body mass index, diabetes, and lower hemoglobin were associated with lower adalimumab durability. In the multivariable model, Hurley stage 3 remained independently associated with less favorable durability (adjusted odds ratio 0.37, 95% confidence interval 0.17-0.81). Comorbid psoriasis was not significantly associated with durability (adjusted odds ratio 2.84, 95% confidence interval 0.96-8.39). Baseline laboratory parameters, including leukocyte and monocyte counts and albumin, did not predict outcome. Age at disease onset, disease duration, and other demographic characteristics were also not associated with durability. CONCLUSION: Hurley stage 3 was independently associated with lower adalimumab durability, while routinely available laboratory measures did not identify additional predictors of long-term treatment outcome.