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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J Am Acad Dermatol

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

Br J Dermatol

Two phase 3 trials of adalimumab for hidradenitis suppurativa.

N Engl J Med

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.

North American clinical management guidelines for hidradenitis suppurativa: A publication from the United States and Canadian Hidradenitis Suppurativa Foundations: Part II: Topical, intralesional, and systemic medical management.

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.

Demystifying trial networks and network meta-analysis.

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

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

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Network meta-analysis, electrical networks and graph theory.

Res Synth Methods

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

Stat Med

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

BMC Med Res Methodol

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

A graphical tool for locating inconsistency in network meta-analyses.

Checking consistency in mixed treatment comparison meta-analysis.

Using network meta-analysis to evaluate the existence of small-study effects in a network of interventions.

CINeMA: An approach for assessing confidence in the results of a network meta-analysis.

PLoS Med

CINeMA: Software for semiautomated assessment of the confidence in the results of network meta-analysis.

Campbell Syst Rev

Efficacy and Safety of Bimekizumab in Moderate to Severe Hidradenitis Suppurativa: A Phase 2, Double-blind, Placebo-Controlled Randomized Clinical Trial.

JAMA Dermatol

Adalimumab for the treatment of moderate to severe Hidradenitis suppurativa: a parallel randomized trial.

Ann Intern Med

IL-17A is a pertinent therapeutic target for moderate-to-severe hidradenitis suppurativa: Combined results from a pre-clinical and phase II proof-of-concept study.

Exp Dermatol

Guselkumab for the treatment of patients with moderate-to-severe hidradenitis suppurativa: a phase 2 randomized study.

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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.

Efficacy and safety of adalimumab in conjunction with surgery in moderate to severe hidradenitis suppurativa: the SHARPS Randomized Clinical Trial.

JAMA Surg

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

J Dermatolog Treat

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.

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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

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

Clinical Summary

What was studied

Key findings

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