A new treatment could offer an alternative to clindamycin (CL) in combination with rifampicin (RF), raising concerns about the development of resistant bacteria due to long-term use.

Clindamycin (CL) monotherapy may be a viable treatment option for patients with hidradenitis suppurativa (HS), especially those with mild or moderate disease, according to the results of a new study published in Annals of Dermatology.

If further studies confirm the safety and efficacy of LC as monotherapy, treatment may offer an alternative to LC in combination with rifampicin (RF), raising concerns about the development of resistant bacteria due to long term use.

“Although HS is not primarily an infectious disease, the RF-CL combination is recommended as a first-line treatment in moderate to severe HS for its antimicrobial, anti-inflammatory and immunomodulatory properties,” the researchers wrote, noting that various species of bacteria have been shown to be involved in the disease. “However, there are still several concerns regarding long-term RF-CL combination therapy.”

According to the researchers, despite concerns about drug-resistant bacteria, as well as several adverse events associated with long-term use of the RF-CL combination, few studies to date have explored possible alternatives to treatment.

In their single-center retrospective study, the researchers found that CL monotherapy was both safe and helpful in 53 patients with HS after 8 weeks of treatment. Resistance to CL occurred in 15% of patients, which the researchers found was lower than the previously reported rate of 65.6%. They add that the presence of bacteria resistant to LC does not seem to have a significant impact on the efficacy of LC monotherapy.

Thirty-four of the patients had efficacy data available, and these showed that 61.76% achieved a clinical response to hidradenitis suppurativa (Hi-SCR). By stage, all patients with stage 1 Hurley disease, 80.0% of patients with stage 2 Hurley disease and 52.17% of patients with stage 3 Hurley disease achieved Hi-SCR.

In addition, the treatment showed more favorable efficacy results in patients with mild or moderate disease compared to patients with severe or very severe disease, which the researchers say is consistent with reports. previous ones.

Of the entire patient cohort, 26.2% experienced an adverse event, 9 of which led to treatment discontinuation. These adverse events included diarrhea, which occurred in 12 of the cases, as well as abdominal pain, rash, and elevated levels of liver enzymes.

“Systemic CL monotherapy may be a safe and useful alternative to RF-CL combination therapy,” the authors concluded, “and no significant difference in the efficacy of therapy based on the presence of bacteria resistant to the CL was observed. “

Nonetheless, they recommend that future trials examine their results to confirm the results seen in this study.

Reference

An JH, Moon SJ, Shin JU, Kim DH, Yoon MS, Lee HJ. Clindamycin monotherapy in patients with hidradenitis suppurativa: single-center retrospective study. Anne Dermatol. 2021; 33 (6): 515-521. doi: 10.5021 / ad.2021.33.6.515