AbstractBackgroundAdalimumab is the only FDA‐approved biologic for hidradenitis suppurativa (HS). In the setting of increasing obesity rates worldwide, the relationship between adalimumab efficacy for HS and BMI is essential to understand. We assessed this relationship through markers of disease severity and inflammation.MethodsInstitutional review board‐approved retrospective chart review of Montefiore/Einstein HS Center (HSC) patients (n = 57) treated with adalimumab. The relationship between BMI and adalimumab efficacy was assessed through disease severity (HS‐Physician Global Assessment [HS‐PGA] 0 and Numerical Rating Scale Pain [NRS‐Pain]) and inflammatory markers (erythrocyte sedimentation rate [ESR], C‐reactive protein [CRP], and interleukin‐6 [IL‐6]). A BMI ≥ 30 is defined as obese; BMI < 30 is defined as non‐obese.ResultsThe mean age was 35.8 ± 13.0 years. After adalimumab therapy, those with BMI < 30 experienced significant reductions in HS‐PGA (−1.5 ± 0.9; P < 0.0001) and NRS‐Pain (−1.6 ± 2.1; P < 0.0001), as well as mean decreases in inflammatory markers ESR, CRP, and IL‐6 (−17.90 ± 23.6, −0.71 ± 1.4, −5.88 ± 7.9, respectively; P > 0.05). Obese patients (BMI ≥ 30) experienced mean increases in HS‐PGA (+0.22 ± 0.8; P > 0.05) and NRS‐Pain scores (+1.41 ± 3.5; P > 0.05) as well as mean increases in ESR, CRP, and IL‐6 (+2.62 ± 28.3, +0.44 ± 3.0, +2.35 ± 6.9, respectively; P > 0.05). Comparing the cohorts, differences in changes in HS‐PGA, NRS‐Pain, ESR, and IL‐6 after therapy are significantly different (P < 0.05).ConclusionsWe identified significantly lower efficacy of adalimumab in HS patients with BMI ≥ 30 compared to those with BMI < 30. Those with BMI ≥ 30 demonstrated signs of both clinical and physiological deterioration while on adalimumab. Future studies are needed to examine adalimumab dosing for HS patients with high BMI, as well as a critical reconsideration of weight‐based therapies.