A network meta-analysis study of monotherapies for hidradenitis suppurativa: analyses of the current evidence base.

Background: The number of monotherapies for hidradenitis suppurativa (HS) has expanded. However, the efficacy of active comparators has not been determined in head-to-head trials.

Aims: We conducted an NMA to determine the relative efficacy and safety of monotherapies for HS.

Methods: The literature was systematically reviewed to obtain data from trials that (1) were published in English, (2) investigated a systemically administered monotherapy with an immunomodulatory agent (3) randomized, and (4) quantified efficacy, at 16 weeks, insofar as the Hidradenitis Suppurativa Clinical Response 50 (HiSCR-50), Dermatology Life Quality Index (DLQI) and Numeric Rating Scale 30 (NRS30). For safety, we analyzed the occurrence of treatment-emergent adverse events (TEAEs). For sensitivity analyses, we conducted network meta-regressions adjusted for age and sex.

Results: We determined the efficacy of numerous regimens including those approved by the United States FDA; for instance, the FDA-approved 'bimekizumab 320 mg every 2 weeks' was more efficacious than 'IFX-1 800 mg every 2 weeks' (odd ratio = 1.99, 95% credible interval: 1.09,3.87, p < 0.05) in terms of HiSCR-50. Sensitivity analyses showed that the main analyses were robust. Overall, risk of bias across studies was low.

Conclusions: The current NMA provides comparative evidence on systematic immunomodulatory HS monotherapies from the most up-to-date trial evidence.