OBJECTIVES: A persistent skin disease, Hidradenitis Suppurativa (HS) causes nodules, abscesses, and tunneling in areas where skin rubs against skin. In this review, we examined the efficacy and safety of pharmaceutical therapies for mild, moderate, and severe HS patients.

METHODS: Literature searches were conducted in EMBASE^®, MEDLINE^®, and Cochrane databases to identify published RCTs in the English language. All records found through the literature search were checked against the pre-defined inclusion and exclusion criteria.

RESULTS: A total of 34 studies from 4,581 published records were included. Adalimumab, anakinra, apremilast, avacopan, bimekizumab, doxycycline, guselkumab, IFX-1, MABp1, PF-06650833, PF-06700841, PF-06826647, povorcitinib, risankizumab, RIST4721, secukinumab, upadacitinib all reported notable clinical benefits, with Hidradenitis Suppurativa Clinical Response (HiSCR) ranged from 10% (anakinra at week 24) to 88% (povorcitinib-90 mg at week 8). Additionally, significant improvements were observed in mean change from baseline in total abscesses and inflammatory nodules count (range: -52.58 for PF-06700841 at week 16 to 60.3 for adalimumab at week 12), draining fistula count (range: -40.1 for spesolimab at week 12 to 31.1 for adalimumab at week 16), and skin pain at week 16 (range: -43.88 for PF-06700841 to -0.1 for IFX-1 400 mg). At week 12, the mean change from baseline in the modified Sartorius score in the adalimumab group was considerably higher than in the placebo (-28.9 vs -9.5). A low rate of serious adverse events (SAEs) was observed in most of the studies. Only upadacitinib (12.2%) and secukinumab (10.5%) had more SAEs. In contrast, no SAEs were detected in spesolimab or anakinra, while bimekizumab had similar safety profiles to adalimumab.

CONCLUSIONS: The results of this review demonstrate the possibility of highly personalized treatment approaches for HS management, including adalimumab and povorcitinib. The optimization of HS care requires further research on long-term outcomes.