JAMA Dermatology

<jats:sec id="ab-doi250030-4"><jats:title>Importance</jats:title><jats:p>There is limited comparative information on regulatory approved and pipeline treatments in hidradenitis suppurativa (HS).</jats:p></jats:sec><jats:sec id="ab-doi250030-5"><jats:title>Objective</jats:title><jats:p>To compare efficacy, safety, and tolerability of treatments for moderate to severe HS.</jats:p></jats:sec><jats:sec id="ab-doi250030-6"><jats:title>Data Sources</jats:title><jats:p>MEDLINE, Embase, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials were searched from inception to June 28, 2024.</jats:p></jats:sec><jats:sec id="ab-doi250030-7"><jats:title>Study Selection</jats:title><jats:p>Phase 2 and 3 randomized clinical trials of medical interventions (cytokine inhibitors, small molecule inhibitors, cell inhibitors, and other novel immune or inflammatory modifiers) for adults with moderate to severe HS having primary efficacy assessments between 12 and 16 weeks.</jats:p></jats:sec><jats:sec id="ab-doi250030-8"><jats:title>Data Extraction and Synthesis</jats:title><jats:p>Data extraction and risk of bias assessments were performed independently by 2 reviewers. Efficacy outcomes were analyzed using random-effects network meta-analysis. Safety and tolerability outcomes were analyzed using pairwise fixed-effect meta-analyses vs placebo. Data analysis was performed between August 22, 2024, and April 7, 2025.</jats:p></jats:sec><jats:sec id="ab-doi250030-9"><jats:title>Main Outcomes and Measures</jats:title><jats:p>Primary efficacy, safety, and tolerability outcomes were Hidradenitis Suppurativa Clinical Response (HiSCR)-50, occurrence of serious adverse events (SAEs), and treatment discontinuation due to adverse events, respectively. HiSCR-75 was a secondary efficacy outcome.</jats:p></jats:sec><jats:sec id="ab-doi250030-10"><jats:title>Results</jats:title><jats:p>Of 26 eligible trials, 25 had available HiSCR-50 data, including 5767 total patients and 39 unique treatments. Compared with placebo, the following treatments were associated with significantly higher HiSCR-50 response rates: sonelokimab, 120 mg, every 4 weeks; lutikizumab, 300 mg, every 2 weeks; adalimumab, 40 mg, once per week; sonelokimab, 240 mg, every 2 weeks; bimekizumab, 320 mg, every 2 weeks; povorcitinib, 15 mg, once per day; bimekizumab, 320 mg, every 4 weeks; secukinumab, 300 mg, every 4 weeks; and secukinumab, 300 mg, every 2 weeks. Most differences between adalimumab, 40 mg, once per week, and other targeted treatments were not statistically significant. The percentage of patients experiencing SAEs ranged from 0% to 10% in the placebo groups, 0% to 8% in the adalimumab (40 mg, once per week) groups, and 0% to 6% in the other active treatment groups. The percentage of patients discontinuing treatment due to adverse events ranged from 0% to 10% in the placebo groups, 0% to 4% in the adalimumab (40 mg, once per week) groups, and 0% to 15% (ropsacitinib) in the other active treatment groups.</jats:p></jats:sec><jats:sec id="ab-doi250030-11"><jats:title>Conclusions and Relevance</jats:title><jats:p>This network meta-analysis provides evidence for the comparative efficacy and safety of currently approved and pipeline medications for moderate to severe HS in the absence of head-to-head trials.</jats:p></jats:sec>

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Factors associated with treatment satisfaction in patients with hidradenitis suppurativa: results from the Global VOICE project.

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Two phase 3 trials of adalimumab for hidradenitis suppurativa.

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Secukinumab in moderate-to-severe hidradenitis suppurativa (SUNSHINE and SUNRISE): week 16 and week 52 results of two identical, multicentre, randomised, placebo-controlled, double-blind phase 3 trials.

Lancet

Efficacy and safety of bimekizumab in patients with moderate-to-severe hidradenitis suppurativa (BE HEARD I and BE HEARD II): two 48-week, randomised, double-blind, placebo-controlled, multicentre phase 3 trials.

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British Association of Dermatologists guidelines for the management of hidradenitis suppurativa (acne inversa) 2018.

European S1 guideline for the treatment of hidradenitis suppurativa/acne inversa.

J Eur Acad Dermatol Venereol

European S2k guidelines for hidradenitis suppurativa/acne inversa part 2: Treatment.

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RoB 2: a revised tool for assessing risk of bias in randomised trials.

Netmeta: an R package for network meta-analysis using frequentist methods.

J Stat Softw

Network meta-analysis, electrical networks and graph theory.

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Reduce dimension or reduce weights? comparing two approaches to multi-arm studies in network meta-analysis.

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Ranking treatments in frequentist network meta-analysis works without resampling methods.

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Consistency and inconsistency in network meta-analysis: concepts and models for multi-arm studies.

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JAMA Dermatol

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Dermatol Ther (Heidelb)

Brepocitinib, zimlovisertib, and ropsacitinib in hidradenitis suppurativa.

NEJM Evid

Efficacy and safety of the oral Janus kinase 1 inhibitor povorcitinib (INCB054707) in patients with hidradenitis suppurativa in a phase 2, randomized, double-blind, dose-ranging, placebo-controlled study.

Proof-of-concept study exploring the effect of spesolimab in patients with moderate-to-severe hidradenitis suppurativa: a randomized double-blind placebo-controlled clinical trial.

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JAMA Surg

Efficacy of non-surgical monotherapies for hidradenitis suppurativa: a systematic review and network meta-analyses of randomized trials.

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Efficacy and safety of biologics and small molecules for moderate-to-severe Hidradenitis Suppurativa: a systematic review and network meta-analysis.

Pharmaceutics

Comparative efficacy and therapeutic positioning of biologics in hidradenitis suppurativa: a systematic review with network meta-analysis of randomised trials.

Indian J Dermatol Venereol Leprol

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J Clin Epidemiol

Absence of evidence is not evidence of absence.

Discuss practical importance of results based on interval estimates and P value functions, not only on point estimates and null P values.

J Inf Technol

There is limited comparative information on regulatory approved and pipeline treatments in hidradenitis suppurativa (HS).
To compare efficacy, safety, and tolerability of treatments for moderate to severe HS.
MEDLINE, Embase, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials were searched from inception to June 28, 2024.
Phase 2 and 3 randomized clinical trials of medical interventions (cytokine inhibitors, small molecule inhibitors, cell inhibitors, and other novel immune or inflammatory modifiers) for adults with moderate to severe HS having primary efficacy assessments between 12 and 16 weeks.
Data extraction and risk of bias assessments were performed independently by 2 reviewers. Efficacy outcomes were analyzed using random-effects network meta-analysis. Safety and tolerability outcomes were analyzed using pairwise fixed-effect meta-analyses vs placebo. Data analysis was performed between August 22, 2024, and April 7, 2025.
Primary efficacy, safety, and tolerability outcomes were Hidradenitis Suppurativa Clinical Response (HiSCR)-50, occurrence of serious adverse events (SAEs), and treatment discontinuation due to adverse events, respectively. HiSCR-75 was a secondary efficacy outcome.
Of 26 eligible trials, 25 had available HiSCR-50 data, including 5767 total patients and 39 unique treatments. Compared with placebo, the following treatments were associated with significantly higher HiSCR-50 response rates: sonelokimab, 120 mg, every 4 weeks; lutikizumab, 300 mg, every 2 weeks; adalimumab, 40 mg, once per week; sonelokimab, 240 mg, every 2 weeks; bimekizumab, 320 mg, every 2 weeks; povorcitinib, 15 mg, once per day; bimekizumab, 320 mg, every 4 weeks; secukinumab, 300 mg, every 4 weeks; and secukinumab, 300 mg, every 2 weeks. Most differences between adalimumab, 40 mg, once per week, and other targeted treatments were not statistically significant. The percentage of patients experiencing SAEs ranged from 0% to 10% in the placebo groups, 0% to 8% in the adalimumab (40 mg, once per week) groups, and 0% to 6% in the other active treatment groups. The percentage of patients discontinuing treatment due to adverse events ranged from 0% to 10% in the placebo groups, 0% to 4% in the adalimumab (40 mg, once per week) groups, and 0% to 15% (ropsacitinib) in the other active treatment groups.
This network meta-analysis provides evidence for the comparative efficacy and safety of currently approved and pipeline medications for moderate to severe HS in the absence of head-to-head trials.

Efficacy and Safety of Medical Interventions for Moderate to Severe Hidradenitis Suppurativa: A Living Systematic Review and Network Meta-Analysis.

Efficacy and Safety of Medical Interventions for Moderate to Severe Hidradenitis Suppurativa

Papers