Evolving the HS Treatment Paradigm, Long-Term Outcomes with IL-17 Inhibition - Episode 11
Monitoring Adverse Effects and Treatment Response of IL-17 Inhibitors in HS
Panelists discuss how they monitor patients through early follow-up visits at 1 to 3 months to assess medication access, manage cutaneous adverse effects, check liver function tests, and use educational handouts and pharmacy support to counsel patients on expected benefits vs risks while maintaining treatment adherence.
Clinical monitoring protocols for IL-17 inhibitors involve early follow-up visits at 1 to 2 months primarily to confirm medication access, address initial cutaneous adverse effects that may impact adherence, and provide reassurance during the period before therapeutic benefit becomes apparent. The critical 3-month assessment point allows determination of treatment response and need for optimization, whether through dose escalation (for secukinumab from every 4 weeks to every 2 weeks) or consideration of alternative therapies if patients show worsening or inadequate improvement.
Safety monitoring includes liver function testing at 3 months based on current labeling requirements for bimekizumab, with ongoing monitoring until sufficient long-term safety data accumulate. Mental health assessment remains important given rare but significant cases of depression or suicidal ideation, though practitioners emphasize that mental health support benefits all patients with hidradenitis suppurativa (HS) regardless of treatment given the high baseline prevalence of psychological distress. Tuberculosis (TB) screening follows traditional protocols before initiating therapy, though the TB reactivation signal for IL-17 inhibitors appears minimal compared with TNF inhibitors.
Patient education tools include comprehensive handouts covering expected benefits, potential adverse effects, and when to seek medical attention, with modern digital formats using QR codes providing easy access to regularly updated resources with hyperlinks to additional support services. Counseling emphasizes that the most common “side effect” patients will experience is disease improvement, helping to balance safety information with realistic expectations about benefit. Many practices employ pharmacists or pharmacy technicians to conduct standardized counseling, reserving physician time for addressing patient-specific concerns and nuanced clinical decision-making while ensuring consistent, thorough safety education.
