Rifampin-moxifloxacin-metronidazole combination therapy for severe Hurley Stage 1 Hidradenitis Suppurativa: prospective short-term trial and one-year follow-up in 28 consecutive patients
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.
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 28 participants or records.
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