ADALIMUMAB use in patients with hidradenitis suppurativa (HS) appears safe with appropriate prophylaxis, as no cases of hepatitis B virus (HBV) or tuberculosis (TB) reactivation were observed in a large retrospective analysis.
The study reviewed outcomes from 462 HS patients followed between January 2017 and June 2024 at a dermatology clinic, of whom 56 received adalimumab. After excluding two patients who did not meet inclusion criteria, 54 individuals treated with adalimumab for at least six months were evaluated. Participants were stratified into five subgroups based on HBV serological status, including natural immunity, chronic infection, isolated anti-HBcIgG positivity, vaccination, and susceptibility.
Twelve patients were considered at risk of HBV reactivation due to their serological profiles. Eight received entecavir prophylaxis and four received tenofovir. During follow-up, none experienced HBV reactivation, as confirmed by serial HBV DNA testing and liver enzyme monitoring.
For TB risk, four patients with latent infection were given isoniazid prophylaxis. No cases of TB reactivation occurred during adalimumab therapy. Reactivation was defined strictly, requiring both clinical and laboratory confirmation such as viral DNA increase or culture positivity.
These findings highlight that although adalimumab carries a theoretical risk of HBV and TB reactivation, careful pre-treatment screening and prophylactic antiviral or antitubercular therapy can mitigate this concern. The data provide reassurance for dermatologists and other clinicians prescribing biologic therapy for HS, a chronic and often debilitating skin condition.
The authors emphasize the importance of identifying high-risk patients through serological and latent TB testing before initiating adalimumab, as well as implementing prophylactic regimens where indicated. Their results support the continued safe use of adalimumab in HS management when appropriate preventive strategies are followed.
Reference: Karakoyun Ö, Ayhan E. Risk of tuberculosis and hepatitis B reactivation during adalimumab use in the treatment of hidradenitis suppurativa. Sci Rep. 2025;15(1):33737.
