A recent post hoc analysis of pooled data from the SUNSHINE and SUNRISE phase 3 trials indicates that secukinumab provides significant benefits in treating not only the physical symptoms of moderate to severe hidradenitis suppurativa (HS) but also associated psychiatric comorbidities such as depression and anxiety. The research, presented at the Society for Dermatology Physician Associates (SDPA) 22nd Annual Fall Dermatology Conference, highlights the holistic impact of secukinumab on patients with HS.
The analysis included data from 1084 patients randomized to receive placebo (N=363) or secukinumab 300 mg every 2 weeks (N=361) or every 4 weeks (N=360) for the initial 16 weeks. The study found that approximately 56.3% of participants were female, with a mean age of 36.2 years. All participants had moderate to severe HS before enrolling in the SUNSHINE and SUNRISE trials. The original studies demonstrated sustained efficacy, improved quality of life, and a favorable safety profile for secukinumab.
Impact on Psychiatric Comorbidities
Psychiatric comorbidity was not an exclusion criterion for the study. At baseline, the prevalence of depression (9.8% vs 3.8% in the general population) and anxiety (7.1% vs 4% in the general population) was notably higher among participants. Approximately 14% of patients were taking antidepressants or anti-anxiety medications, with escitalopram (1.7%), citalopram (1.4%), lorazepam (1.4%), and sertraline (1.4%) being the most common.
The European QoL 5-Dimension (EQ-5D) questionnaire was used to assess mood and anxiety symptoms. At week 16, a greater proportion of patients treated with secukinumab reported feeling "not depressed or anxious" compared to the placebo group. This improvement was sustained at week 52, and patients who switched from placebo to secukinumab also showed improvement.
Emotional Well-being and Symptom Impact
Researchers utilized the HS Symptom and Impact Diary (HSSID) to evaluate the emotional impact of HS symptoms. Patients rated the impact of HS on their emotions over the past 24 hours on a scale from 0 (not at all) to 3 (a great deal). Patients in the active treatment groups showed the most significant and sustained improvement through week 52, regardless of their pre-existing history of depression or anxiety.
Psychiatric Adverse Effects
The incidence of psychiatric adverse effects was generally low across all treatment groups. Among the more serious adverse events, there were two cases of suicidal ideation and one suicide attempt, all occurring in patients with pre-existing depression who were receiving treatment prior to the study. Depression (not major depression) was the most frequently reported event, followed by insomnia and anxiety.
Conclusions
"These findings highlight the positive benefits achieved by patients when treated with secukinumab for HS, particularly with respect to mental and emotional well-being, which is likely due to a holistic effect and overall symptom improvement in patients with HS," the authors concluded.
