New BTK inhibitor shows promise in hidradenitis suppurativa

Over 70% of patients taking remibrutinib reported a 50% reduction in abscesses and inflammatory nodules.

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A novel treatment for hidradenitis suppurativa has led to encouraging results in a phase IIb trial. 

A late breaking abstract at the 2024 American Academy of Dermatology’s annual meeting reports an investigational Bruton’s tyrosine kinase inhibitor significantly improves hidradenitis suppurativa disease status. 

Seventy-seven patients with moderate to severe hidradenitis suppurativa participated in the US phase IIb trial, where 66 received either 50mg or 200mg of remibrutinib per day for 16 weeks. Eleven patients received placebo, who were pooled with a further 50 placebo patients from other cohort studies. 

After 16 weeks, 72.7% of patients receiving the lower dose of remibrutinib experienced at least a 50% reduction in their total abscess and inflammatory nodule count (i.e., meeting the criteria for the simplified Hidradenitis Suppurativa Clinical Response), compared to 48.5% of patients receiving the higher dose and 34.7% of the pooled control patients.  

The lower dose of remibrutinib also led to greater reductions in draining-tunnel count (55.6% for 50mg compared to 43.0% for the 200mg dose and 10.2% for placebo). In contrast, the higher dose led to a greater proportion of patients experiencing a 30% reduction in self-reported skin pain (57.1%, compared to 44.4% for the lower dose and 30.4% for placebo) 

Presenting author Dr Alexa Kimball was excited by the possibility of using remibrutinib in combination with other existing therapies. 

“The overall results are in line with what we’re seeing with the most effective therapies we have, but it’s way too early to make any distinguishing comparisons,” she said. 

“What I think is most exciting is that it is a different mechanism of action that we feel like is perhaps complementary to some of our other therapies. As we try to push the field forward and make sure that we can get patients to higher levels of efficacy, being able to potentially combine therapies or tailor the therapy to their stage in the process of the disease is really an opportunity.” 

BTK inhibitors, more commonly used to treat haematological conditions, target the B cells found within hidradenitis suppurativa lesions.  

The remibrutinib therapy was “well tolerated… [with] expected [and] mostly mild to moderate” adverse events, Dr Kimball said, and had a similar safety profile to placebo.