Secukinumab for Hidradenitis Suppurativa
Secukinumab is now FDA-approved for the treatment of moderate-to-severe hidradenitis suppurativa (HS) that is unresponsive to conventional systemic therapy, representing a significant advancement in treatment options beyond adalimumab. 1
Current Status of Secukinumab in HS Treatment
- Secukinumab, an interleukin-17A inhibitor, has recently received FDA approval for the treatment of moderate-to-severe HS, becoming the second biologic therapy approved for this condition after adalimumab 2, 1
- Earlier guidelines from 2019 listed secukinumab under "insufficient evidence to recommend" category, but this has changed with recent clinical trial data 3
- The most recent North American clinical practice guidelines (2025) now suggest using secukinumab for pediatric patients with HS aged 6 years and older who require biologics 3
Efficacy of Secukinumab in HS
- The SUNSHINE and SUNRISE phase III trials demonstrated that secukinumab administered every 2 weeks was significantly more effective than placebo in achieving Hidradenitis Suppurativa Clinical Response (HiSCR) at week 16 4
- In the SUNSHINE trial, 45% of patients receiving secukinumab every 2 weeks achieved HiSCR compared to 34% on placebo 4
- In the SUNRISE trial, 42% of patients receiving secukinumab every 2 weeks and 46% of patients receiving secukinumab every 4 weeks achieved HiSCR compared to 31% on placebo 4
- The clinical response to secukinumab was sustained up to 52 weeks of treatment 4
Efficacy Based on Prior Biologic Exposure
- Secukinumab has shown efficacy in both biologic-naïve and biologic-experienced patients 5
- At week 16, HiSCR rates for biologic-experienced patients were 37.0% for secukinumab every 2 weeks and 38.8% for secukinumab every 4 weeks, compared to 27.3% for placebo 5
- For biologic-naïve patients, HiSCR rates were 45.6% for secukinumab every 2 weeks and 45.4% for secukinumab every 4 weeks, compared to 34.2% for placebo 5
- This positions secukinumab as a viable option for both first-line biologic therapy and for patients who have previously been treated with other biologics such as adalimumab 5
Safety Profile
- The safety profile of secukinumab in HS is consistent with that observed in other approved indications, with no new or unexpected safety findings 4
- The most common adverse event reported in clinical trials was headache (9-12% of patients on secukinumab) 4
- Secukinumab should be used with caution in patients with inflammatory bowel disease due to potential exacerbation 2
Place in Treatment Algorithm
- Secukinumab should be considered for moderate-to-severe HS that is unresponsive to conventional systemic therapy 2, 1
- Conventional systemic therapy typically includes:
- Adalimumab remains the other FDA-approved biologic option for moderate-to-severe HS 1
Clinical Considerations
- Treatment response should be assessed using the Hidradenitis Suppurativa Clinical Response (HiSCR), which measures reduction in inflammatory lesions 6
- Quality of life improvement using DLQI and pain reduction using Visual Analog Scale should also be monitored 6
- Patients who do not respond to one biologic may benefit from switching to the other FDA-approved option 2, 1
- The IL-17/Th17 axis plays an important role in HS pathophysiology, providing the rationale for secukinumab's effectiveness 2
Special Populations
- Secukinumab is suggested for pediatric patients with HS aged 6 years and older who require biologic therapy 3
- Limited data exists for secukinumab use in pregnancy, breastfeeding, and elderly populations with HS 6
In conclusion, secukinumab represents an important addition to the therapeutic armamentarium for moderate-to-severe hidradenitis suppurativa, with demonstrated efficacy in both biologic-naïve and biologic-experienced patients.