The role of interleukin inhibitors in the treatment of hidradenitis suppurativa; a systematic review of clinical trials

Abstract

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder that presents significant treatment challenges. Recent advancements have enhanced our understanding of its pathophysiology, leading to the development of novel therapeutic strategies. This systematic review evaluates the role of interleukin (IL) inhibitors as emerging treatment options for HS. A systematic search was conducted in PubMed/Medline, Scopus, and Web of Science databases for studies published up to September 2nd, 2024, with inclusion limited to clinical trials available in English. The National Institute of Health (NIH) Quality Assessment Tool for clinical trials and before-after studies with no control group was used to assess the methodological quality of the included studies. Out of 1289 studies, 20 met our inclusion criteria involving 3957 patients. Moreover, four ongoing trials were retrieved from ClinicalTrials.gov. Secukinumab showed sustained hidradenitis Suppurativa Clinical Response (HiSCR) improvements, particularly in biologic-naïve patients with common adverse events (AEs). Bimekizumab was effective with biweekly dosing, while the four-week regimen had inconsistent results, with rare reports of AEs. Brodalumab and bermekimab provided rapid and sustained HiSCR responses with lesion reductions, which were well tolerated. Guselkumab and ustekinumab showed promising but statistically nonsignificant improvements with mild AEs. Risankizumab did not significantly improve HiSCR rates but showed Dermatology Life Quality Index (DLQI) benefits. Anakinra offered moderate efficacy with prolonged exacerbation-free periods but led to some treatment discontinuations. Spesolimab reduced inflammatory lesions and draining tunnels while maintaining a favorable safety profile. IL inhibitors, especially IL-17 inhibitors, have demonstrated efficacy in treating moderate-to-severe HS, while IL-23 inhibitors have shown inconsistent results. Despite their generally favorable safety profiles, further research is needed to optimize treatment strategies and assess long-term outcomes.