Risk of tuberculosis and hepatitis B reactivation during adalimumab use in the treatment of hidradenitis suppurativa

Recently, adalimumab has become an important drug frequently used by dermatologists in the treatment of Hidradenitis suppurativa. While there are many publications by rheumatologists about the risk of hepatitis B and tuberculosis reactivation, the literature on reactivation in the treatment of hidradenitis is not extensive. With this study, we wanted to emphasize that adalimumab is a safe drug despite the risk of hepatitis B and tuberculosis reactivation and the importance of porphylaxis during the treatment of hidradenitis suppurativa. In this study, data from 462 HS patients followed up at the Dicle University Dermatology Clinic between 1 January 2017 and 30 June 2024 were retrospectively analyzed. Adalimumab use was detected in 56 of the 462 patients. Patients over 18 years of age and used adalimumab for at least 6 months were selected for this study. Two of these patients were not included in the study because they did not meet the criteria for age and duration of adalimumab use. All the participants were divided into 5 subgroups according to their HBV serological test results: natural immunity, chronic HBV infection, isolated anti-HBcIgG positivity, vaccinated and susceptible. Hepatitis B reactivation was detected only in those with positive anti-HBc IgG (chronic HBV infection, isolated anti-HBcIgG positivity, and natural immunity) tests who were at risk of reactivation. To investigate reactivation, HBV DNA test results before and after biological treatment and ALT-AST levels during the continuation of biological treatment were examined. Patients with a positive HBV DNA test before biological therapy and an increase of > 1 log10İU/ml in the HBV DNA titer during biological therapy and patients with a negative HBV DNA test before biological therapy and a positive HBV DNA test during the biological therapy use period were considered reactivation positive. Patients for whom no HBV DNA test was performed during the study period, those who had one positive HBV DNA test result before or after biological treatment and the other test result was not investigated, and those who had never been checked after starting biological treatment were not included in the reactivation investigation. For tuberculosis reactivation, those who had a latent tuberculosis test (quantitative test), did not report any symptoms and were chronic carriers were included. Among the patients with a positive latent TB test and suspicious clinical and radiological evaluation during biological treatment, those with a positive culture were considered reactivation positive. Of the 12 patients at risk of hepatitis B reactivation during adalimumab treatment, 8 received entecavir, and 4 received tenofovir prophylaxis. No hepatitis B reactivation was observed in any of the 12 patients during adalimumab treatment. Among the 54 patients, 4 were at risk of TB reactivation, and 4 received isoniazid as preophylactic treatment. None of the 4 patients were observed to have TB reactivation. Adalimumab has become a frequently preferred drug in the treatment of hidradenitis, and it is known that there is a risk of hepatitis b and TBc reactivation, which should be prevented. Despite these risks, we found that adalimumab can be safely used to treat hidradenitis suppurativa, especially with the use of prophylaxis.