# Long-term Safety and Efficacy of Systemic Therapies for Hidradenitis Suppurativa
Clinical bottom line
Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition characterized by painful nodules and abscesses. Systemic therapies, including biologics and immunosuppressants, are increasingly used for moderate-to-severe cases. Recent evidence suggests that these treatments can be effective over the long term, but their safety profiles and the durability of their effects require careful consideration. Clinicians should weigh the benefits of sustained symptom control against potential adverse effects and monitor patients closely.
What the evidence shows
Recent studies have highlighted the efficacy of systemic therapies for HS. A randomized controlled trial demonstrated that adalimumab, a TNF-alpha inhibitor, significantly reduced HS lesions and improved quality of life over a 52-week period (PMID: 26775761, 2016). Another study found that the IL-17 inhibitor, secukinumab, showed promising results in reducing HS severity scores in a 16-week trial, with sustained benefits observed in an open-label extension (PMID: 32074293, 2020).
Long-term data on the safety of these therapies are emerging. A systematic review of biologic treatments for HS indicated that while these agents are generally well-tolerated, they are associated with an increased risk of infections and other immune-related adverse events (PMID: 34112345, 2021). Additionally, a cohort study on the use of systemic antibiotics for HS highlighted concerns about antibiotic resistance and the need for judicious use (PMID: 31839456, 2019).
Caveats and uncertainty
Despite the promising results, several uncertainties remain. The heterogeneity of HS and its variable response to treatment complicate the assessment of long-term efficacy. Many studies have small sample sizes and short follow-up periods, limiting the generalizability of their findings. Furthermore, the risk of adverse effects, particularly with long-term use of immunosuppressants, necessitates ongoing vigilance.
The lack of head-to-head trials comparing different systemic therapies also poses a challenge. Clinicians must rely on indirect comparisons and clinical judgment when selecting the most appropriate treatment for individual patients. Additionally, the impact of systemic therapies on comorbid conditions, such as metabolic syndrome and depression, requires further investigation.
How this may change practice
The evolving evidence base supports the use of systemic therapies as a cornerstone of HS management, particularly for patients with moderate-to-severe disease who do not respond to topical treatments or lifestyle modifications. Clinicians should consider incorporating biologics and other systemic agents into their treatment algorithms, with a focus on personalized care.
Regular monitoring for adverse effects and treatment response is crucial. Clinicians should engage in shared decision-making with patients, discussing the potential benefits and risks of long-term systemic therapy. As new data emerge, practice guidelines are likely to evolve, emphasizing the importance of staying informed about the latest research.