Biologics for Hidradenitis Suppurativa: Are They Right for You?

These medications include:

• adalimumab (Humira)
• bimekizumab-bkzx (Bimzelx)
• infliximab (Remicade)
• secukinumab (Cosentyx)

More approvals may be coming down the pike.

Each type of biologic targets a specific protein thought to play a role in triggering the inflammation that contributes to HS.

Your treatment options will depend on the severity of HS, which is classified by stage, called Hurley stages:

• Stage 1 (mild): You have one or a few lesions in one area of your body.
• Stage 2 (moderate): Nodules get bigger and may appear in more than one area of your body. You may experience some scarring or tunneling.
• Stage 3 (severe): You have widespread abscesses with extensive scarring or tunneling and chronic pain.

Stage 1 HS may be managed with warm compresses, antibacterial or antiseptic washes, or NSAIDs. For stages 2 and 3, your doctor may prescribe antibiotics, corticosteroids, retinoids, hormone therapy, or biologics. “When you have a lot of new nodules and have tried other treatments, that’s when you should consider a biologic,” says Dr. Hamzavi.

Adalimumab, bimekizumab-bkzx, and secukinumab are self-injected at home. Infliximab is administered as an infusion at a hospital or clinic.

“Different options are given at different intervals,” says Maria Aleshin, MD, a clinical associate professor of dermatology and the director of the HS clinic at Stanford Medicine in Emeryville, California. Depending on the drug, you may need to take it weekly, every other week, monthly, or once every two months.

You may start to notice some improvement in symptoms after three months. “But we really want to stick it out to about the six-month mark to make sure we understand the maximum benefits that you’re able to get from this medication,” says Haley Naik, MD, vice president of the Hidradenitis Suppurativa Foundation and a dermatologist at the University of California in San Francisco.

Because biologics can take a bit of time to start kicking in, “Some dermatologists will prescribe additional therapy, like an antibiotic, to help bridge the gap until the biologic starts working,” says Dr. Aleshin.

Biologics are pioneers when it comes to HS treatment. “This is a disease for which really no good treatments existed for many decades,” says Dr. Naik. “Biologics have completely changed the way we treat HS and are more effective than any previous treatment we’ve used to treat this disease.”

The caveat is that they don’t work for everyone. “For some, a biologic can be incredibly effective. For others, it can be partially effective,” she adds. “The main takeaway is that it’s hard to predict how you’re going to respond to biologics unless you try them.”

Each type of biologic has its own unique set of risks and side effects. The most common are pain and redness at the injection site and cold or flu-like symptoms. Because biologics work by suppressing the immune system, they may increase your risk of infection. They also come with a very low risk of certain types of cancer. And biologics may reactivate latent tuberculosis or hepatitis B or C infections, so you’ll need to be tested for those before starting a biologic.

That said, studies have shown that these biologics are safe, effective, and well tolerated and provide meaningful results for people with HS.

Biologics can cost $10,000 to $30,000 a year — and potentially in excess of $500,000 a year for the most expensive ones. The good news: Those that have been approved by the FDA for HS are usually covered by insurance, says Aleshin.

You may still have out-of-pocket costs, but how much you’ll need to pay depends on your insurance plan. If you have trouble getting insurance approval or are concerned about paying for a biologic, talk to your doctor, who can help you find a solution that meets your insurance and treatment needs. They can also discuss your financial assistance options, such as patient assistance programs that some pharmaceutical companies offer to help lower the cost of medication.