Deciphering Evolving Biologic Strategies for Hidradenitis Suppurativa

At the recent Dermatology Times Horizons in Advanced Practice meeting in Tampa, Florida, conference chairs Lakshi Aldredge, MSN, ANP-BC, DCNP; Omar Noor, MD; and Douglas DiRuggiero, DMSc, MHS, PA-C, reviewed complex atopic dermatitis, type 2 inflammation, psoriasis, chronic hand eczema, and hidradenitis suppurativa (HS) patient cases to an exclusive group of dermatology nurse practitioners and physician assistants in 6 breakout groups.

Aldredge, an adult nurse practitioner at the VA Portland Healthcare System in the Dermatology Service and the director of the Primary Care NP Residency Program in Portland, Oregon, first presented “Hands-On Solutions: Advancing Care in Chronic Hand Eczema.” In her second session, Aldredge discussed biologic efficacy for HS, specifically reviewing adalimumab (Humira; AbbVie), secukinumab (Cosentyx; Novartis), and bimekizumab (bimekizumab; UCB).

Stay tuned to Dermatology Times for a deep dive into each chair’s sessions, as well as more interviews with Noor and DiRuggiero.

Interview With Lakshi Aldredge, MSN, ANP-BC, DCNP

Q: What did you review in your second breakout session on HS?

Aldredge: The hidradenitis suppurativa session was really exciting. We spent a lot of time focusing on biologic treatments for HS, since these have revolutionized the way that we treat this tough condition. We focused on the first treatment, which was adalimumab [Humira; AbbVie], and then we had secukinumab [Cosentyx; Novartis], and now we have bimekizumab [Bimzelx; UCB]. Having IL-17 options and more targeted therapy has provided phenomenal relief for these patients who suffer so much; there was a lot of interaction about the efficacy. Even though bimekizumab and secukinumab are both IL-17 inhibitors, we did see some differences in efficacy. The safety profiles for all of these treatments were relatively similar, but it's really nice to have these options.

One of the other key takeaways from this session was the relapse rate of HS. This is a condition that, regardless of which treatment patients are on, we start to see a waning response after a period of time. Sometimes there is a need to switch back and forth between the biologics. We also talked about supplemental treatments, including vitamin D, zinc gluconate, metformin, and potentially, the role of GLP-1 inhibitors in this disease as well.

Q: What were some of the key discussion points from attendees?

Aldredge: The attendees wanted to focus on what the clinical indications are for how to get some of these newer biologic agents approved for HS. What the group largely noted was that, because this is such a difficult disease to treat, it has not been difficult to get the biologics approved. So, in some conditions, such as psoriasis or atopic dermatitis, it can be a challenge to get these expensive biologics approved. In the case of HS, which is kind of an orphan disease that has no real treatments other than the FDA-approved adalimumab, secukinumab, and bimekizumab, it has not been a challenge to be able to get these drugs. Everyone knows, including the insurers, that this is a difficult disease to treat with a lot of comorbidities and impacts on quality of life.

Q: What message would you share with fellow NPs and PAs about getting more involved in speaking and writing opportunities?

Aldredge: I would say, for any NP or PA who is looking to advance their professional development, when I first started out in dermatology 24 years ago, I did not feel like I would ever see myself on a stage or publishing an article or delivering a lecture. But what I really started doing was I was encouraged by my peers. It started out with me publishing a very simple case study that had a great outcome with one of my patients. I published it in the Dermatology Nurses’ Association peer-reviewed journal, and that was my first foray. I was terrified of doing it.

The second time I published, I was asked to do an article on sentinel lymph node biopsies and melanoma, something that I didn't feel like I was an expert in at all, but it caused me to do a lot of research. I wrote the article, I had it reviewed by numerous people who I would consider subject matter experts, and lo and behold, it was actually accepted for publication. So, it was not something that came to me comfortably, but really challenged me. As a result, I was able to gain confidence and then further develop my ability to become more scholarly and to look at science and the evidence and read more articles. As I did that, I found myself becoming more knowledgeable and then more comfortable in sharing my newfound knowledge with my peers.

There are so many great resources that are available if you are interested in publishing. Every single professional organization, SDNP, SDPA, Dermatology Nurses’ Association all offer courses and workshops on how to publish. I think those are incredibly helpful, especially if you're terrified of taking that plunge. There are a lot of great resources out there to help you with that.

Finally, I think that so many of our online virtual presentations give us an opportunity to share our expertise with our colleagues, even from the comfort of our own homes. There's some comfort in that you don't have to feel like you have to go to a meeting and sit on the stage or stand on the stage and deliver a lecture. I think there are ways that you can ease into that, by doing virtual lectures for your professional organization, say on a monthly webinar, or even at a local dermatology NP or PA meeting in your community, or even to your primary care colleagues. There are lots of ways that we can ease into that professional development role of speaking or publishing, and thankfully, we have so many great venues to do that and vehicles for gaining expertise in those skill sets.

Click here for all interviews with the Horizons meeting chairs.