Hidradenitis Suppurativa Treatment Efficacy and Safety

Efficacy Comparison

The American Academy of Dermatology recommends adalimumab as a first-line biologic therapy for moderate-to-severe hidradenitis suppurativa, with a well-established efficacy profile 1
Adalimumab demonstrated HiSCR response rates of 42% in PIONEER 1 and 59% in PIONEER 2 trials at week 12, compared to 26% and 28% for placebo 1
Adalimumab has a favorable benefit-risk ratio with a number needed to treat (NNT) of 4 and a number needed to harm (NNH) of 26 for serious adverse events 2

The treatment algorithm recommends adalimumab 160mg at week 0, 80mg at week 2, then 40mg weekly starting at week 4 as a first-line biologic therapy for moderate-to-severe hidradenitis suppurativa unresponsive to antibiotics 1, 3

Monitoring treatment response using HiSCR is recommended, which measures reduction in inflammatory lesions 3, 4
Assessing quality of life improvement using DLQI and pain reduction using Visual Analog Scale is also recommended 3, 5
Non-responders at 12 weeks on adalimumab may still achieve response with continued treatment, with 40% of initial non-responders achieving response by week 36 1
Response may be lost over time, with almost half of adalimumab responders at week 12 losing response by week 36 despite continued weekly dosing 1
Patient comorbidities, such as obesity and inflammatory bowel disease, should be considered when treating hidradenitis suppurativa 2

Adalimumab is FDA-approved for children aged 12 years and older with moderate to severe hidradenitis suppurativa 3, 5
Limited data exists for biologics in pregnancy, breastfeeding, and elderly populations with hidradenitis suppurativa 2