Biologics for hidradenitis suppurativa: evolution of the treatment paradigm

Expert Rev Clin Immunol. 2023 Dec 22. doi: 10.1080/1744666X.2023.2298356. Online ahead of print.ABSTRACTINTRODUCTION: Hidradenitis suppurativa (HS) is an autoinflammatory skin disease with a high unmet need for effective medical management. Clinically, it is characterized by inflammatory nodules that may progress into abscesses, draining tunnels and extensive scarring, mainly affecting apocrine gland-bearing areas. Although its pathophysiology is still incompletely understood, high levels of Interleukin (IL)-1/17/23 and Tumor Necrosis Factor (TNF)-α have been demonstrated.AREAS COVERED: Treatment options include topical, systemic medications and a variety of surgical procedures. The anti-TNF-α antibody adalimumab and the anti-IL-17 secukinumab are the only two approved biologics for HS, showing moderate efficacy. HS research is a rapidly growing field, with a wide range of agents leveraging distinct mechanisms of action currently under development. Drugs targeting the IL-17 and Janus kinase/signal transducer and activator of transcription (JAK/STAT) pathways are the most advanced in both ongoing and completed Phase 3 studies, promising deeper levels of response. Use of other, off-label biologics is also discussed.EXPERT OPINION: A therapeutic algorithm is proposed based on comorbidities and existing evidence. Patient-tailored combinations between biologics and other biologics or small molecules will hopefully allow clinicians to target most events in HS pathophysiology in a...
Source: Expert Review of Clinical Immunology - Category: Allergy & Immunology Authors: Source Type: research