CURRENT BIOLOGIC THERAPIES FOR MODERATE-TO-SEVERE HIDRADENITIS SUPPURATIVA: A NARRATIVE REVIEW OF APPROVED TREATMENTS AND CLINICAL IMPLICATIONS
DOI:
https://doi.org/10.31435/ijitss.3(51).2026.6123Keywords:
Hidradenitis Suppurativa, Adalimumab, Secukinumab, Bimekizumab, Interleukin-17Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by recurrent painful nodules, abscesses, and sinus tracts, resulting in substantial impairment of quality of life. Advances in the understanding of HS immunopathogenesis have led to the development of biologic therapies targeting key inflammatory pathways, particularly TNF-α and IL-17. To summarize current evidence regarding approved biologic therapies for moderate-to-severe HS, focusing on their mechanisms of action, efficacy, safety, and clinical applicability. A narrative literature review was conducted using the PubMed/MEDLINE database. Studies published between January 2016 and June 2026 were screened using the terms “hidradenitis suppurativa”, “adalimumab”, “secukinumab”, “bimekizumab”, and names of pivotal clinical trials. Randomized controlled trials, extension studies, real-world evidence reports, and high-quality reviews were included. Data were qualitatively synthesized. Adalimumab, the first approved biologic for HS, demonstrated significant efficacy in the phase III PIONEER I and II trials, with sustained long-term benefits. Secukinumab showed superior clinical response rates compared with placebo in the phase III SUNSHINE and SUNRISE studies. Bimekizumab demonstrated promising efficacy in both phase II and phase III BE HEARD trials, improving disease activity, pain, and quality of life. Overall, biologic therapies targeting TNF-α and IL-17 pathways consistently improved clinical outcomes in patients with moderate-to-severe HS. Adalimumab remains the established first-line biologic agent, while secukinumab and bimekizumab provide effective alternatives for patients with poor response to TNF-α inhibition. Despite encouraging efficacy and safety data, complete disease remission remains difficult to achieve, highlighting the need for further therapeutic advances.
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