M Delage1, J-P Jais2, T Lam1, H Guet-Revillet3, M-N Ungeheuer4, P-H Consigny1, A Nassif1, O Join-Lambert5. 1. Centre Médical, Institut Pasteur, 75015, Paris, France; Centre d'Infectiologie Necker Pasteur, 75015, Paris, France. 2. Unit of Biostatistics, Hôpital Necker-Enfants malades, Assistance Publique - Hôpitaux de Paris, 75015, Paris, France; INSERM U1163, Institut Imagine, 75015, Paris, France; Université de Paris, Paris, France. 3. Department of Bacteriology, Centre Hospitalier Universitaire Purpan, Toulouse, France. 4. ICAReB platform, Center for Translational Science, Institut Pasteur, 75015, Paris, France. 5. Normandie Univ, UNICAEN, UNIROUEN, CHU de Caen Normandie, Department of Microbiology, Groupe de Recherche sur l'Adaptation Microbienne (GRAM 2.0, EA 2656), 14000 Caen, France. Electronic address: olivier.join-lambert@unicaen.fr.
Abstract
BACKGROUND: Severe Hurley stage 1 Hidradenitis suppurativa (HS1) is a difficult to treat form of the disease. OBJECTIVE: To assess the efficacy and tolerance of the oral combination of rifampin (10 mg/kg once daily) - moxifloxacin (400 mg once daily) - metronidazole (250 to 500 mg t.i.d) (RMoM) treatment strategy in severe HS1 patients. METHODS: Prospective, open-label, non-comparative cohort study in 28 consecutive patients. 19 patients were treated for 6 weeks by RMoM, followed by 4 weeks of RMo alone, then by cotrimoxazole after remission. Moxifloxacin was replaced by pristinamycin (1g t.i.d) in 9 cases because of contra-indications or intolerance. Primary endpoint was a Sartorius score of 0 (clinical remission, CR) at week 12. RESULTS: The median Sartorius score dropped from 14 to 0 (p= 6 x 10-6) at week 12, 75% of patients reaching CR. A low initial Sartorius score was a prognosis factor for CR (p = 0.049). Main side-effects were mild gastro-intestinal discomfort, mucosal candidiasis and asthenia. At one year of follow-up, the median [IQR] number of flares dropped from 21/year to 1 (p = 10-5). LIMITATIONS: small monocentric non-controlled study. CONCLUSION: complete and prolonged remission can be obtained in severe HS1 using targeted antimicrobial treatments.
BACKGROUND: Severe Hurley stage 1 Hidradenitis suppurativa (HS1) is a difficult to treat form of the disease. OBJECTIVE: To assess the efficacy and tolerance of the oral combination of rifampin (10 mg/kg once daily) - moxifloxacin (400 mg once daily) - metronidazole (250 to 500 mg t.i.d) (RMoM) treatment strategy in severe HS1patients. METHODS: Prospective, open-label, non-comparative cohort study in 28 consecutive patients. 19 patients were treated for 6 weeks by RMoM, followed by 4 weeks of RMo alone, then by cotrimoxazole after remission. Moxifloxacin was replaced by pristinamycin (1g t.i.d) in 9 cases because of contra-indications or intolerance. Primary endpoint was a Sartorius score of 0 (clinical remission, CR) at week 12. RESULTS: The median Sartorius score dropped from 14 to 0 (p= 6 x 10-6) at week 12, 75% of patients reaching CR. A low initial Sartorius score was a prognosis factor for CR (p = 0.049). Main side-effects were mild gastro-intestinal discomfort, mucosal candidiasis and asthenia. At one year of follow-up, the median [IQR] number of flares dropped from 21/year to 1 (p = 10-5). LIMITATIONS: small monocentric non-controlled study. CONCLUSION: complete and prolonged remission can be obtained in severe HS1 using targeted antimicrobial treatments.