## **Supplemental Online Content**

Nosrati A, Ch'en PY, Torpey ME, et al. Efficacy and durability of intravenous ertapenem therapy for recalcitrant hidradenitis suppurativa. Published online February 14, 2024. *JAMA Derm*. doi:10.1001/jamadermatol.2023.6201

**eAppendix 1.** HS-PGA severity scoring system

**eAppendix 2.** Questions used in survey and results

**eAppendix 3.** Ertapenem treatment course duration

**eAppendix 4.** Months on biologic therapy prior to ertapenem therapy

**eAppendix 5.** Aerobic and anaerobic culture results during intravenous ertapenem therapy

**eAppendix 6.** Before and after 12-16-week course of ertapenem

This supplemental material has been provided by the authors to give readers additional information about their work.

**Appendix 1.** HS-PGA severity scoring system

| HS-PGA Score | | Definition |
|--------------|-----------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Clear | (Score=0) | 0 abscesses, 0 draining fistulas, 0 inflammatory nodules, and 0 noninflammatory nodules |
| Minimal | (Score=1) | 0 abscesses, 0 draining fistula, 0 inflammatory nodules, and presence of noninflammatory nodules |
| Mild | (Score=2) | 0 abscesses, 0 draining fistulas, and 1-4 inflammatory nodules; or 1 abscess or draining fistula and 0 inflammatory nodules |
| Moderate | (Score=3) | 0 abscess, 0 draining fistulas, and ≥ 5 inflammatory nodules; or 1 abscess or draining fistula and ≥1 inflammatory nodule; or 2-5 abscess or draining fistulas and <10 inflammatory nodules |
| Severe | (Score=4) | 2-5 abscesses or draining fistulas and ≥ 10 inflammatory nodules |
| Very Severe | (Score=5) | >5 abscesses or draining fistulas |

**Appendix 2.** Questions used in survey and results

| | Survey; n=76 |
|----|--------------------------------------------------------------------------------------------|
| 1. | How satisfied are you with your overall experience with ertapenem? |
| | a. Very Satisfied 42(55.3) |
| | b. Satisfied 19 (25.0) |
| | c. Neutral 11 (14.5) |
| | d. Dissatisfied 4 (5.3) |
| | e. Very Dissatisfied 0 (0) |
| 2. | Would you be willing to receive another course of ertapenem? |
| | a. Yes 60 (78.9) |
| | b. No 16 (21.1) |
| 3. | Would you recommend ertapenem to another patient with HS? |
| | a. Yes 69 (90.8) |
| | b. No 6 (7.9) |
| 4. | Think back to the midpoint of your ertapenem course. On a scale from 1 to 5 where 1 is |
| | much worse, 3 is neutral, and 5 is much better please rate how you were feeling at that |
| | time compared to baseline in regard to: mean (SD) |
| | a. Severity of HS flares: 4.4 (0.77) |
| | b. Frequency of HS flares: 4.4 (0.79) |
| | c. Duration of HS flares: 4.5 (0.77) |
| | d. Your level of pain: 4.4 (0.84) |
| | e. Your amount of drainage: 4.4 (0.85) |
| | f. Your mood: 4.1 (0.92) |
| | g. Your mobility 4.1 (0.97) |
| | h. Your sleep quality 3.9 (1.00) |
| | i. Your quality of life 4.3 (0.91) |
| 5. | Think back to after you completed the ertapenem course. On a scale from 1 to 5 where |
| | 1 is much worse, 3 is neutral, and 5 is much better please rate how you were feeling at |
| | that time compared to baseline in regard to: mean (SD) |
| | a. Severity of flares 4.4 (1.00) |
| | b. Frequency of HS flares 4.3 (0.96) |
| | c. Duration of HS flares 4.4 (0.92) |
| | d. Your level of pain 4.4 (0.95) |
| | e. Your amount of drainage 4.3 (1.00) |
| | f. Your mood 4.0 (1.00) |
| | g. Your mobility 4.13 (1.10) |
| | h. Your sleep quality 3.9 (1.0) |
| | i. Your quality of life 4.2 (1.0) |
| 6. | How many weeks did it take for you to see any improvement to treatment? 2.5 (1.4) |
| 7. | How many weeks did it take for you to achieve maximum improvement on therapy? 5.8 (3.4) |
| 8. | Did you experience a flare after stopping ertapenem? |
| | |

| | a. Yes 58 (76.3%) |
|-----|------------------------------------------------------------------------------------|
| | b. No 13 (17.1%) |
| 9. | If yes to question 9, how many weeks after stopping ertapenem did you experience a |
| | flare? 6.1 (8.3) |
| 10. | Did you experience any adverse effects while on ertapenem? 14 (18.4%) |

**Appendix 3.** Ertapenem treatment course duration

![](https://assets.reachrx.ai/images/10.1001%E2%98%8Djamadermatol.2023.6201/_page_4_Figure_1.jpeg)

**Appendix 4.** Months on biologic therapy prior to ertapenem therapy

![](https://assets.reachrx.ai/images/10.1001%E2%98%8Djamadermatol.2023.6201/_page_5_Figure_1.jpeg)

![](https://assets.reachrx.ai/images/10.1001%E2%98%8Djamadermatol.2023.6201/_page_6_Figure_0.jpeg)

**Appendix 5.** Aerobic and anaerobic culture results during intravenous ertapenem therapy

© 2024 American Medical Association. All rights reserved.

![](https://assets.reachrx.ai/images/10.1001%E2%98%8Djamadermatol.2023.6201/_page_7_Picture_0.jpeg)

**Appendix 6.** Before and after 12-16-week course of ertapenem. Thigh (e, f)

JAMA Dermatology

<jats:sec id="ab-doi230075-4"><jats:title>Importance</jats:title><jats:p>Hidradenitis suppurativa (HS) is a debilitating follicular skin disorder in which bacterial colonization is typical. Oral antibiotic efficacy can be unreliable; however, selective intravenous antibiotics, specifically ertapenem, may provide favorable clinical outcomes.</jats:p></jats:sec><jats:sec id="ab-doi230075-5"><jats:title>Objective</jats:title><jats:p>To explore optimal course duration, efficacy, and patient satisfaction associated with intravenous ertapenem for HS.</jats:p></jats:sec><jats:sec id="ab-doi230075-6"><jats:title>Design, Setting, and Participants</jats:title><jats:p>This retrospective review of the medical records of 98 patients with HS between 2018 and 2022 measured and evaluated patient outcomes before and after treatment with intravenous ertapenem. Participants were followed up in a telephone survey assessing patient perspectives and satisfaction. All of those included in this study received medical care from the Albert Einstein College of Medicine’s Montefiore HS Center.</jats:p></jats:sec><jats:sec id="ab-doi230075-7"><jats:title>Exposures</jats:title><jats:p>Patients were treated with 1 g of ertapenem that was self-administered at home through a peripheral intravenous central catheter using an elastomeric pump for 12 to 16 weeks. Antiandrogens and immunomodulatory biologic therapies initiated prior to ertapenem were maintained throughout the treatment course.</jats:p></jats:sec><jats:sec id="ab-doi230075-8"><jats:title>Main Outcomes and Measures</jats:title><jats:p>The primary outcomes, encompassing clinical severity (evaluated through the HS Physician Global Assessment score [a 6-point scale ranging from clear to very severe] and a numerical rating scale for pain [an 11-point scale in which a score of 0 indicates no pain and a score of 10 indicates the worst possible pain]) and markers of inflammation (such as leukocytes, erythrocyte sedimentation rate, C-reactive protein, and interleukin-6), were measured at baseline, the midcourse of intravenous ertapenem treatment, at the end of the course, and posttherapy. Bacterial abundance was also examined at these 4 points, and patient satisfaction was assessed during follow-up.</jats:p></jats:sec><jats:sec id="ab-doi230075-9"><jats:title>Results</jats:title><jats:p>A total of 98 patients (mean [SD] age, 35.8 [13.0] years; 61 [62.2%] female) with HS were treated with intravenous ertapenem. The self-reported racial distribution included 3 individuals identifying as Asian (3.1%), 59 as Black/African American (60.2%), 13 as White (13.3%), and 23 as either other or unknown (23.5%). Additionally, 24 participants (24.5%) reported Spanish/Hispanic/Latino ethnicity. The mean (SD) treatment duration spanned 13.1 (4.0) weeks, with posttherapy follow-up occurring after 7.8 (3.6) weeks. From baseline to posttherapy follow-up, significant reductions were found in the mean (SD) HS Physician Global Assessment scores (3.9 [1.0] vs 2.7 [1.2]; <jats:italic>P</jats:italic> &amp;amp;lt; .001) and the numerical rating scale for pain (4.2 [3.3] vs 1.8 [2.7]; <jats:italic>P</jats:italic> &amp;amp;lt; .001), C-reactive protein (5.4 [11.4] vs 2.4 [2.0] mg/dL; <jats:italic>P</jats:italic> &amp;amp;lt; .001), interleukin-6 (25.2 [21.1] vs 13.7 [13.9]; <jats:italic>P</jats:italic> &amp;amp;lt; .001), and leukocytes (11.34 [3.9] vs 10.0 [3.4]; <jats:italic>P</jats:italic> &amp;amp;lt; .001). At follow-up, 76 patients (78.0%) participated in the telephone survey, where 63 (80.3%) reported medium to high satisfaction; further, 69 (90.8%) would recommend ertapenem to other patients.</jats:p></jats:sec><jats:sec id="ab-doi230075-10"><jats:title>Conclusions and Relevance</jats:title><jats:p>In this retrospective review of medical records and telephone survey, treating HS with intravenous ertapenem, administered for a mean of 13 weeks, was associated with improvement in clinical and inflammatory markers, as well as heightened patient satisfaction. Nonetheless, this approach should be monitored for the emergence of antimicrobial resistance given a longer than standard treatment course.</jats:p></jats:sec>

The handicap of hidradenitis suppurativa.

Dermatol Clin

Depression is a frequent co-morbidity in patients with acne inversa.

J Dtsch Dermatol Ges

North American Clinical Management Guidelines for hidradenitis suppurativa: a publication from the United States and Canadian Hidradenitis Suppurativa Foundations: part I: diagnosis, evaluation, and the use of complementary and procedural management.

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Intramuscular ertapenem for the treatment of severe cases hidradenitis suppurativa.

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Dermatol Ther (Heidelb)

Hidradenitis suppurativa (HS) is a debilitating follicular skin disorder in which bacterial colonization is typical. Oral antibiotic efficacy can be unreliable; however, selective intravenous antibiotics, specifically ertapenem, may provide favorable clinical outcomes.
To explore optimal course duration, efficacy, and patient satisfaction associated with intravenous ertapenem for HS.
This retrospective review of the medical records of 98 patients with HS between 2018 and 2022 measured and evaluated patient outcomes before and after treatment with intravenous ertapenem. Participants were followed up in a telephone survey assessing patient perspectives and satisfaction. All of those included in this study received medical care from the Albert Einstein College of Medicine's Montefiore HS Center.
Patients were treated with 1 g of ertapenem that was self-administered at home through a peripheral intravenous central catheter using an elastomeric pump for 12 to 16 weeks. Antiandrogens and immunomodulatory biologic therapies initiated prior to ertapenem were maintained throughout the treatment course.
The primary outcomes, encompassing clinical severity (evaluated through the HS Physician Global Assessment score [a 6-point scale ranging from clear to very severe] and a numerical rating scale for pain [an 11-point scale in which a score of 0 indicates no pain and a score of 10 indicates the worst possible pain]) and markers of inflammation (such as leukocytes, erythrocyte sedimentation rate, C-reactive protein, and interleukin-6), were measured at baseline, the midcourse of intravenous ertapenem treatment, at the end of the course, and posttherapy. Bacterial abundance was also examined at these 4 points, and patient satisfaction was assessed during follow-up.
A total of 98 patients (mean [SD] age, 35.8 [13.0] years; 61 [62.2%] female) with HS were treated with intravenous ertapenem. The self-reported racial distribution included 3 individuals identifying as Asian (3.1%), 59 as Black/African American (60.2%), 13 as White (13.3%), and 23 as either other or unknown (23.5%). Additionally, 24 participants (24.5%) reported Spanish/Hispanic/Latino ethnicity. The mean (SD) treatment duration spanned 13.1 (4.0) weeks, with posttherapy follow-up occurring after 7.8 (3.6) weeks. From baseline to posttherapy follow-up, significant reductions were found in the mean (SD) HS Physician Global Assessment scores (3.9 [1.0] vs 2.7 [1.2]; P < .001) and the numerical rating scale for pain (4.2 [3.3] vs 1.8 [2.7]; P < .001), C-reactive protein (5.4 [11.4] vs 2.4 [2.0] mg/dL; P < .001), interleukin-6 (25.2 [21.1] vs 13.7 [13.9]; P < .001), and leukocytes (11.34 [3.9] vs 10.0 [3.4]; P < .001). At follow-up, 76 patients (78.0%) participated in the telephone survey, where 63 (80.3%) reported medium to high satisfaction; further, 69 (90.8%) would recommend ertapenem to other patients.
In this retrospective review of medical records and telephone survey, treating HS with intravenous ertapenem, administered for a mean of 13 weeks, was associated with improvement in clinical and inflammatory markers, as well as heightened patient satisfaction. Nonetheless, this approach should be monitored for the emergence of antimicrobial resistance given a longer than standard treatment course.

Efficacy and Durability of Intravenous Ertapenem Therapy for Recalcitrant Hidradenitis Suppurativa.

Efficacy and Durability of Intravenous Ertapenem Therapy for Recalcitrant Hidradenitis Suppurativa

Efficacy and Durability of Intravenous Ertapenem Therapy for Recalcitrant Hidradenitis Suppurativa

Clinical Summary

What was studied

Key findings

Study limitations

Clinical implications

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