BIMEKIZUMAB showed the strongest short-term efficacy among hidradenitis suppurativa biologics in trials assessed at Week 12 to 16.
Hidradenitis Suppurativa Biologics Compared in a Network Meta Analysis
With limited head-to-head evidence for approved biologic therapies in hidradenitis suppurativa (HS), investigators conducted a systematic literature review (SLR) and Bayesian network meta-analysis (NMA) to compare short term efficacy. Randomized controlled trials published through 3rd July 2024 were included, and analyses focused on Week 12 to 16 outcomes for bimekizumab 320 mg every 2 weeks, secukinumab 300 mg every 2 weeks and every 4 weeks, and adalimumab 40 mg every week.
To reflect clinical heterogeneity in prior biologic exposure, the authors built two evidence networks: one predominantly biologic naive and one predominantly biologic experienced. Outcomes included HS Clinical Response (HiSCR) thresholds of at least 50%, 75%, 90%, and 100%, change from baseline in International Hidradenitis Suppurativa Severity Score System (IHS4), and improvement from baseline of at least 55% (IHS4 55). Abscess and inflammatory nodule (AN) count and draining tunnel (DT) count changes were also assessed.
Bimekizumab Ranked Highest Across Predefined Efficacy Outcomes
Across nine trials, bimekizumab ranked as the most efficacious treatment for all predefined outcomes in both networks, with consistent response levels. In the predominantly biologic naive network, bimekizumab every 2 weeks demonstrated significantly higher odds of response than secukinumab every 4 weeks for all HiSCR outcomes, including HiSCR50 (odds ratio 1.69), HiSCR75 (1.85), HiSCR90 (1.62), and HiSCR100 (1.88), as well as IHS4 55 (1.91). Bimekizumab also showed higher odds of HiSCR75 (1.60) and HiSCR90 (1.56) versus adalimumab every week.
In the biologic experienced network, the analysis similarly favored secukinumab every 2 weeks and both secukinumab dosing regimens versus comparators, while bimekizumab remained the top ranked option overall. The authors noted that adalimumab studies did not report the proportion of biologic experienced participants, which may limit interpretability for that network.
Clinical Takeaways and Remaining Evidence Gaps
The authors describe this as the first NMA in moderate to severe HS to adjust for intercurrent events across multiple efficacy outcomes, producing updated comparative estimates among approved options. They also emphasized that a systematic review of safety data is needed to support full benefit risk assessment and treatment decision making, given the short-term focus of the current comparisons.
Reference: Naik HB et al. Short-term efficacy of biologics in moderate-to-severe hidradenitis suppurativa: A systematic review and NMA. J Eur Acad Dermatol Venereol. 2025;doi:10.1111/jdv.70265.
