What is the comparative efficacy and safety of Secukinumab, Adalimumab (adalimumab), and Bimekizumab for the treatment of Hidradenitis suppurativa?

Comparative Efficacy of Adalimumab, Secukinumab, and Bimekizumab for Hidradenitis Suppurativa

Adalimumab is currently the most well-established biologic treatment for moderate-to-severe hidradenitis suppurativa, with the strongest evidence supporting its efficacy and safety profile, while Bimekizumab has shown promising results in recent trials with higher HiSCR50 response rates of 48-52% compared to adalimumab's 42-59%. 1, 2, 3

Efficacy Comparison

Adalimumab

• FDA-approved for moderate-to-severe hidradenitis suppurativa with a well-established efficacy profile 3
• Demonstrated HiSCR response rates of 42% in PIONEER 1 and 59% in PIONEER 2 trials at week 12 (vs 26% and 28% for placebo) 3
• Weekly dosing (40mg) is significantly more effective than every-other-week dosing, with NNT of 5 for clinical response 4
• Has favorable benefit-risk ratio with NNT of 4 and NNH of 26 for serious adverse events 3
• Improves quality of life measures and pain scores in patients with moderate-to-severe disease 4

Bimekizumab

• Recently studied in BE HEARD I and II phase 3 trials with promising results 2
• Achieved HiSCR50 response rates of 48% in BE HEARD I and 52% in BE HEARD II at week 16 (vs 29% and 32% for placebo) 1, 2
• Both every 2 weeks and every 4 weeks dosing regimens showed efficacy, with responses maintained or increased through week 48 2
• Associated with improvement in patient-reported worst skin pain compared to placebo 1
• FDA approval status for hidradenitis suppurativa is recent (2024) 1

Secukinumab

• Limited data available in the provided evidence specifically for hidradenitis suppurativa 5
• Recently FDA-approved for hidradenitis suppurativa as mentioned in 2024 evidence 5
• In network meta-analysis, secukinumab 300mg every 2 weeks and every 4 weeks showed significant improvement in HiSCR50 compared to placebo 6

Safety Comparison

Adalimumab

• Well-established safety profile with extensive clinical experience 3
• Serious adverse event rates of 7.8% for weekly dosing vs 3.9% for placebo in clinical trials 7
• Long-term safety data available through multiple clinical trials and post-marketing surveillance 3

Bimekizumab

• Serious treatment-emergent adverse events reported in 5-8% of patients over 48 weeks 2
• Most common adverse events include hidradenitis exacerbation, oral candidiasis, headache, and diarrhea 1, 2
• No new safety signals identified in phase 3 trials 2

Secukinumab

• Limited specific safety data provided for hidradenitis suppurativa in the evidence 6, 5
• Network meta-analysis showed percentage of patients experiencing serious adverse events ranged from 0-6% in active treatment groups 6

Treatment Algorithm Based on Evidence

1. First-line biologic therapy: Adalimumab 160mg at week 0, 80mg at week 2, then 40mg weekly starting at week 4 for moderate-to-severe hidradenitis suppurativa unresponsive to antibiotics 3, 8

2. Alternative biologic options if inadequate response to adalimumab after 16 weeks:

   • Bimekizumab 320mg every 2 weeks, which has shown higher HiSCR50 response rates in recent trials 1, 2
   • Secukinumab 300mg as another IL-17 inhibitor option 6, 5

3. Dosing considerations:

   • For adalimumab, weekly dosing is superior to every-other-week dosing 4, 7
   • For bimekizumab, both every 2 weeks and every 4 weeks dosing regimens have shown efficacy 1, 2

Clinical Pearls and Pitfalls

• Monitor treatment response using HiSCR (Hidradenitis Suppurativa Clinical Response), which measures reduction in inflammatory lesions 8, 9
• Assess quality of life improvement using DLQI and pain reduction using Visual Analog Scale 8, 10
• Be aware that non-responders at 12 weeks on adalimumab may still achieve response with continued treatment (40% of initial non-responders achieved response by week 36) 3
• Recognize that response may be lost over time - almost half of adalimumab responders at week 12 lost response by week 36 despite continued weekly dosing 3
• Consider patient comorbidities as HS is associated with obesity, inflammatory bowel disease, arthritis, and metabolic syndrome 3
• Encourage weight loss and smoking cessation as adjunctive measures to improve treatment outcomes 8, 10

Special Populations

• Adalimumab is FDA-approved for children aged 12 years and older with moderate to severe hidradenitis suppurativa 8, 10
• Limited data exists for biologics in pregnancy, breastfeeding, and elderly populations with hidradenitis suppurativa 3
• Treatment recommendations for children and adolescents are largely based on case reports and extrapolation from adult data 3