With three biologics now approved for hidradenitis suppurativa (HS), the question for a lot of patients is a simple one: Does one actually work better over time? An analysis published earlier this year offers some answers.
As reported by Dermatology Times, researchers compared roughly one-year results (weeks 48 to 52) for three biologics approved for adults with moderate to severe HS: bimekizumab (Bimzelx), secukinumab (Cosentyx) and adalimumab (Humira). Since no trial has tested these drugs directly against each other, the team used a statistical method called a matching-adjusted indirect comparison, lining up patient characteristics across existing trial data (including age, BMI, smoking status, disease severity and prior biologic use) to make the comparison as fair as possible. The findings were published in the Journal of the European Academy of Dermatology and Venereology.
What the Analysis Found
Compared with secukinumab, bimekizumab had higher odds of clinical response at every threshold measured (HiSCR, a standard score for how much HS lesions improve). It was also linked to greater quality-of-life improvements, fewer flares and bigger reductions in the painful inflammatory nodules and draining tunnels that define the condition.
Against adalimumab, bimekizumab was more likely to reach the 50 and 75 percent response thresholds and showed greater reductions in nodules and tunnels. At the stricter 90 percent threshold, though, the differences were smaller and not consistently statistically significant.
Bimekizumab also held onto its favorable results in patients who had already been on a biologic before. The drug works by blocking two inflammatory proteins, IL-17A and IL-17F.
The Fine Print
This wasn’t a head-to-head trial. The method relies on the assumption that all the important factors were matched between trial populations, so some bias from unmeasured differences could remain. Safety also wasn’t formally compared, since it was reported inconsistently across the studies, which means this isn’t a complete picture of how the treatments stack up.
What This Means for You
Until a true head-to-head trial happens, analyses like this give patients and their dermatologists more to weigh when choosing a biologic, especially for people who have already tried one and are considering a switch. And for those with milder HS, topical options are being studied too.
