Evolving Treatment Paradigms for Hidradenitis Suppurativa: The Role of Biologics

Hidradenitis suppurativa (HS) is a challenging autoinflammatory skin disease characterized by painful, recurrent inflammatory nodules, abscesses, draining sinuses, and scarring in areas rich in apocrine glands. According to a study published in Expert Review of Clinical Immunology, there is a substantial unmet need for effective treatments for HS, given its severe impact on patients' quality of life and limited therapeutic options.

Currently, treatment for HS includes both topical and systemic medications, as well as a variety of surgical interventions. Two biologics—adalimumab, an anti-TNF-α antibody, and secukinumab, an anti-IL-17 antibody—are approved for HS, although they demonstrate moderate efficacy. However, the field of HS treatment research is expanding rapidly. New therapeutic agents targeting key pathways in HS pathophysiology, particularly the IL-17 and Janus kinase/signal transducer and activator of transcription, or JAK/STAT, pathways, have reached advanced stages of clinical testing. These therapies are designed to achieve deeper and more lasting responses in patients with HS. Additionally, the use of off-label biologics is being explored to broaden treatment options.

The study proposes a therapeutic algorithm for HS, emphasizing the importance of tailoring treatment to individual patient needs, especially considering coexisting health conditions. The goal is to develop personalized combinations of biologics and small-molecule therapies to address the complex pathology of HS more comprehensively. By targeting multiple pathways simultaneously, clinicians may achieve better control of the severe manifestations of HS, offering hope for improved outcomes for patients living with this challenging condition.

Reference
Maronese CA, Moltrasio C, Genovese G, Marzano AV. Biologics for hidradenitis suppurativa: evolution of the treatment paradigm. Expert Rev Clin Immunol. 2024;20(5):525-545. doi:10.1080/1744666X.2023.2298356