Moderate to Severe HS: Might Be Time to Try Biologics

Secukinumab (Cosentyx)

In 2023, the FDA approved the second biologic for HS, secukinumab. It targets IL-17A, another protein involved in inflammation. Secukinumab also reduces how bad your symptoms can get, and it may help you if you have severe HS and didn’t see improvements from adalimumab.

• How it’s given. Secukinumab is given as a shot under your skin. You’ll typically start with weekly shots for the first five weeks, then switch to monthly.
• What to expect. It can take up to four months of treatment for your symptoms to get better, but you might have some relief after just a few weeks.

Other Biologics Used Off-Label

Although these biologics aren’t specifically approved by the FDA for HS, they’re sometimes prescribed off-label, meaning they’re used in a way that’s not officially approved but can still be effective.

Infliximab (Remicade)

Infliximab also targets TNF-alpha, like adalimumab, but you get it as an infusion through a vein (IV) rather than as a shot. Infliximab is usually used for severe cases of HS when other treatments haven’t worked.

• How it’s given. Infliximab is given through an IV at a health care facility. You’ll get the first doses every eight weeks, and then adjusted to every six to four weeks, depending on how you respond.
• What to expect. You may start to notice improvement after a few infusions, but like other biologics, it can take several weeks to see the full benefit.

Ustekinumab (Stelara)

This biologic targets two proteins, IL-12 and IL-23, which play a role in inflammation. Ustekinumab is sometimes used off-label for HS, particularly when TNF blockers like adalimumab or infliximab aren’t effective.

• How it’s given. Ustekinumab is also given as a shot. Studies looked at dosing ranging from every four weeks to every 12 weeks.
• What to expect. It can take several weeks and dosing adjustments for you to notice an improvement, but many people see significant relief over time.

What Are the Side Effects of Biologics?

Like all medications, biologics can cause side effects, including: 

Infection. Since biologics suppress parts of your immune system, the most common side effect is a higher risk of infections. So, you may be more likely to get respiratory infections, sinus infections, or skin infections. It's important to contact your doctor if you feel unwell or notice signs of an infection.

Injection site reactions. Some people have redness, swelling, or pain where they get their shot. This usually goes away after a few days.

How Long Until You See Results?

Biologics aren’t a quick fix. While some people start to notice an improvement in their symptoms within a few weeks, it can take several months to see the full benefits. 

It’s important to be patient and continue with the treatment as prescribed, even if you don’t see improvement right away. Your doctor will likely schedule regular checkups to monitor your progress and adjust your treatment if needed.

Do Biologics Work for Everyone?

Biologics can be very effective for many people with moderate to severe HS, but they don’t work for everyone. You may not respond to the first biologic you try, so your doctor may switch you to a different one. It’s also possible that one will be successful, but then stop working over time. If that happens, your doctor may adjust your treatment or suggest other options.

How Much Do Biologics Cost? Are They Covered by Insurance?

Biologic treatments can be expensive, often costing thousands of dollars per month. But most insurance plans, including Medicare and Medicaid, cover biologics for HS. Before starting treatment, it’s a good idea to check with your insurance company to understand your coverage and out-of-pocket costs.

Patient assistance programs

Many drug companies offer patient assistance programs to help cover the cost of biologics. These programs can lower your out-of-pocket expenses, especially if you don’t have insurance or your insurance doesn’t fully cover the treatment.

What Biologics Are Being Researched for HS?

Researchers are studying new biologics for HS. Some of these treatments target different parts of the immune system than the biologics currently available. 

One experimental biologic, bimekizumab (Bimzelx), has shown promise in early studies. It targets both IL-17A and IL-17F, two proteins involved in inflammation. In one small study, people with HS saw fast results with few side effects. 

Another experimental biologic, lutikizumab, which targets IL-1A and IL-1B, is currently being studied in people with HS. It’s too early to know how the drug is working. 

Risankizumab (Skyrizi) was also studied in people with HS. It works by targeting the protein IL-23. But the drug failed to show significant improvement in patients. Some people also got side effects that made their HS worse.

Is It Time to Try Biologics for Your HS?

If your HS has become hard to manage, and other treatments haven’t worked, biologics might be worth considering. They can help reduce inflammation, prevent flare-ups, and improve your quality of life. Talk to your doctor about whether biologics are a good option for you, and if so, which one might be the best fit based on your symptoms and medical history.

Biologics can offer hope for people with moderate to severe hidradenitis suppurativa. While they aren’t a cure, they can make a big difference in managing your symptoms of HS when other treatments don’t. 

By working closely with your doctor, you can decide if this treatment is right for you and start a plan that brings you relief and helps you live more comfortably.