Advancing Hidradenitis Suppurativa Care - Early Diagnosis, Biologic Therapies, and Multidisciplinary Approaches: Part 2

Conversation continued from part 1.

Current and Emerging Treatment Paradigms

The discussion heralded what Lev-Tov described as the “golden age” of HS, marked by a surge in therapeutic innovations. Three FDA-approved biologics are currently available—bimekizumab (Bimzelx; UCB), adalimumab (Humira; AbbVie), and secukinumab (Cosentyx; Novartis)—and the pipeline for HS treatments is expanding rapidly. According to Lev-Tov, recent advancements include the following:

• Phase 3 trials: Multiple clinical trials are underway, with some nearing completion. These studies include both injectable and oral therapies, offering hope for diverse treatment options.
• Combination therapies: Real-world experiences suggest that combining biologics with other treatments, such as surgical interventions, enhances outcomes. Adjusting dosing frequencies, such as transitioning from 4-week to 2-week intervals, has also shown promise.
• Nonmedication innovations: There is a pressing need for advancements in surgical techniques, wound care, and targeted pain management, which are areas that have yet to see significant innovation.

Lev-Tov urged pharmaceutical companies and regulatory authorities to provide flexible dosing options, allowing clinicians to tailor treatments to individual patient needs. This approach recognizes the variability in HS presentation and response to therapy.

Digital Tools and Support Systems

Innovative digital tools such as the Papaya app, developed with input from key advisers Vivian Shi, MD, and Hsiao in collaboration with patients with HS, are empowering patients to track their pain and symptoms daily. Such tools enhance patient-clinician communication and facilitate more personalized care. Elias emphasized the importance of leveraging patient-driven organizations and online resources, such as HS Connect and Hope for HS, which fill critical gaps in support and education.

For clinicians, the HS Foundation’s website offers valuable resources, including templates to streamline prior authorization processes for both on-label and off-label treatments. These tools are instrumental in overcoming administrative hurdles and ensuring timely access to care.

Translating Research Into Practice

Although clinical trials often report aggregate data, such as Hidradenitis Suppurativa Clinical Response (HiSCR), these metrics may not fully capture individual patient outcomes. Lev-Tov encouraged clinicians to interpret trial data with an understanding of their limitations and to consider real-world applications. Combining therapies and customizing treatment plans can often yield results that exceed expectations set by clinical trial benchmarks.

According to Elias and Lev-Tov, the explosion of research and innovation is transforming HS from a condition that once felt untreatable into one with a growing array of therapeutic options. However, challenges remain. Misdiagnosis, delayed treatment, and gaps in surgical and wound care innovation highlight areas where continued focus is needed.

Biologic Therapies and Precision Medicine

Elias and Hamzavi, a board-certified dermatologist at Hamzavi Dermatology and Dermatology Specialists in Canton, Michigan, and president of the HS Foundation, discussed the evolving landscape of biologic therapies, precision medicine, surgical interventions, and the role of artificial intelligence (AI) in personalizing care for patients with HS. Elias first highlighted the growing interest in biologic-specific testing, aiming to tailor treatment regimens based on individual patient profiles. This approach seeks to determine the most effective biologic agent and dosing for each patient. Hamzavi elaborated on the progress in using trough levels of infliximab (Remicade; Janssen Biotech) and adalimumab—data commonly applied in gastroenterology—to refine HS treatment strategies. Monitoring these levels can help identify treatment failures, whether due to insufficient dosing or the development of drug-related antibodies.

However, challenges remain in translating these findings to HS. Although inflammatory bowel disease has established thresholds for these biomarkers, correlating them to HS-specific outcomes such as pain, drainage, and quality of life is still a work in progress. Hamzavi noted ongoing research into genetic markers and their role in disease pathophysiology, including keratinocyte growth and wound healing responses. Although precision biomedicine holds promise, widespread clinical application in HS may be years away.

Emerging Biologics and Biomarkers

Elias and Hamzavi also reviewed new biologic agents targeting B- and T-cell pathways, including antibodies tagged to CD38. Although these agents are in early research stages, they demonstrate the push toward more targeted therapies. According to Hamzavi, the critical question remains: Do these biomarkers translate into actionable data for real-world practice across diverse settings? Large-scale clinical trials will be essential to validate their use.

The Role of Artificial Intelligence

Hamzavi emphasized the potential of AI in advancing HS care. By synthesizing diverse inputs—such as patient history, genetic data, and simple laboratory tests—AI could categorize patients more effectively and predict therapeutic responses. He argued that AI might help bypass reliance on costly biomarkers by integrating readily available data to optimize treatment selection. However, he cautioned that any advancements must ultimately reduce patient harm and improve outcomes.

Discussion continued in part 2.