Martina J. Porter, MD, is a dermatologist at Beth Israel Deaconess Medical Center.

Martina Porter, MD

Discussing Findings on Secukinumab (Cosentyx) Efficacy Over 4 Years in HS, With Martina Porter, MD

New late-breaking, phase 3 data have been released demonstrating secukinumab’s (Cosentyx) efficacy over 4 years in patients with 

These new post-hoc analysis findings were presented during the 10th annual Symposium on Hidradenitis Suppurativa Advances (SHSA). 

 spoke about the findings with Martina J. Porter, MD, a trial investigator, assistant professor of dermatology at Harvard Medical School, and vice chair for research and academics at Beth Israel Deaconess Medical Center.

“You've seen the data from the core trials that led to the FDA approval, and we have shown the Week 104 data as well, but now we're getting data all the way out to Week 204,” Porter said. “So, this is the longest, long-term extension data that we have now for any IL-17 inhibitor in HS, and it's really impactful and reassuring, both from a safety and efficacy perspective. Also, I think it reinforces what we've talked about before, that IL-17 really doesn't have immunogenicity, and so patients tend to maintain their response for many years.”

Porter highlighted details of the post-hoc analysis, noting patients with moderate to severe HS were evaluated previously in the SUNSHINE and SUNRISE core and extension trials. Those who had attained a clinical response at the 52-week mark (HiSCR responders) were included. These findings, Porter highlighted, show the evolution of clinical response up to the 204-week mark

Clinical response was evaluated by Porter and coauthors as a reduction of 50% (HiSCR50), 75% (HiSCR75), 90% (HiSCR90), or 100% (HiSCR100) in study participants’ total number of inflammatory abscesses and nodules. The investigators found, among HiSCR responders at the 52-week mark, 81.3% sustained HiSCR50 between 1 and 4 years. Also, Porter et al found in that same timeframe, 72.9%, 46.9%, and 35.4% of those assessed improved their response to secukinumab from HiSCR50 to HiSCR75, HiSCR90, and HiSCR100, respectively.

“So it's very good,” Porter explained. “The safety data was very in line with secukinumab’s known safety profile for all its other indications, even though this is the highest dose of secukinumab used for any indication. I think that's very reassuring. So nothing exciting, fortunately, in the safety data. And compared to the other IL-17 inhibitors that are approved for HS, like bimekizumab, there are relatively low rates of fungal infections, hypersensitivities, or rashes in the secukinumab patients out to 4 years.”

Porter also highlighted secukinumab treatment’s impact on draining tunnels, which the investigative team had found saw a notable decrease of 68.5% in draining tunnels maintained by patients treated with the medication. Overall, secukinumab was well-tolerated and had a strong safety profile, consistent with previously shared data.

“The safety profile of secukinumab long term is probably better than bimekizumab, if you look at the percentages of some of the adverse reactions that we commonly associate with IL-17 inhibitors…” Porter said. “But I think when we talk about shared decision making with patients, it helps to guide management, because I have different groups of patients who are really looking for immediate efficacy results versus mostly choosing the absolutely safest drug they can. So I think having this long-term data can really help guide those decisions.”

For any additional information on these findings on secukinumab in patients with HS, view the full interview posted above.

The quotes contained in this summary were edited for clarity.

Porter M, Zouboulis C, Kimball A. Four-year efficacy and safety of continuous secukinumab in HS: SUNSHINE/SUNRISE core and extension trials. Poster presented at the 10th Annual Symposium on Hidradenitis Suppurativa Advances (SHSA), Nashville, TN, USA, October 31–November 02, 2025.

Kimball AB, Bechara FG, Alavi A, et al. Long-term efficacy and safety of secukinumab in patients with moderate-to-severe hidradenitis suppurativa: week 104 results from the SUNSHINE and SUNRISE extension trial. Br J Dermatol. 2025 Mar 18;192(4):629-640. 

Kunzmann K. FDA Approves Secukinumab for Hidradenitis Suppurativa. HCPLive. November 1, 2023. Accessed November 13, 2025. 

https://www.hcplive.com/view/fda-approves-secukinumab-hidradenitis-suppurativa

Videos

This interview highlights long-term, phase 3 data from the SUNSHINE and SUNRISE core and extension trials on secukinumab for hidradenitis suppurativa.

Panelists discuss how key research gaps include pediatric studies, understanding disease progression to enable early intervention, managing acute flares, addressing cosmetic concerns from scarring and hyperpigmentation, and highlight educational resources available through the HS Foundation, medical conferences, and specialized training programs.

Exploring Research Needs and Resources in HS Care

Critical research gaps in hidradenitis suppurativa (HS) include the need for pediatric studies, as current approval for adalimumab in patients aged 14 years and above relied on pharmacokinetic modeling rather than dedicated pediatric trials. Understanding disease progression and identifying predictive biomarkers could enable earlier intervention in patients at high risk for severe disease development, potentially altering the natural history through timely therapeutic intervention. Management of acute flares represents another pressing need, as current biologics reduce flare frequency but don’t eliminate them, leaving patients and providers without evidence-based rescue strategies.

Emerging research questions include whether early disease control can prevent the metabolic and inflammatory comorbidities commonly associated with HS or whether some comorbidities actually contribute to disease initiation and could be targeted for prevention. The relationship between HS and conditions like arthritis, inflammatory bowel disease, and metabolic syndrome requires deeper investigation to optimize holistic patient care. Additionally, addressing the cosmetic impact of residual scarring and hyperpigmentation after achieving inflammatory control represents an important quality of life consideration, with preliminary work exploring ablative lasers, fractional treatments, and microneedling approaches adapted from acne scar management.

Educational resources for clinicians continue expanding through multiple channels including the annual HiSTORIC conference, resident symposia that have evolved from niche events to high-demand educational opportunities, and online learning platforms. The HS Foundation website provides practical tools including prior authorization resources, wound care guidance, and educational modules for emergency department physicians and other nondermatology providers. Academic supplements, surgical video libraries, journal clubs, and basic science seminars through professional organizations offer ongoing learning opportunities at various career stages, supporting the growing community of practitioners committed to advancing HS care and improving patient outcomes.

Panelists discuss how the pipeline includes promising therapies like sonelokimab (an IL-17A/F nanobody with potential for better tissue penetration), various JAK inhibitors, IL-1α/β inhibitors, OX40 ligand blockers, and B-cell targeted therapies that may address disease heterogeneity and offer hope for patients with treatment-resistant disease. 

Emerging Therapies in HS

Sonelokimab represents the newest IL-17 pathway inhibitor in development, utilizing nanobody technology to target both IL-17A and IL-17F with potentially enhanced tissue penetration due to its smaller molecular size. Phase 2 data demonstrated that approximately half of patients achieved HiSCR75, marking the first hidradenitis suppurativa (HS) trial to use this more stringent end point that better reflects clinically meaningful improvement and patient satisfaction. The nanobody structure may offer advantages in tissue penetration and potentially improved safety profile, though larger phase 3 studies will be necessary to confirm whether the cutaneous adverse events observed with other IL-17A/F inhibitors occur at similar rates.

The broader pipeline includes diverse mechanisms targeting various aspects of HS pathophysiology, reflecting growing understanding of disease heterogeneity. Combination IL-1α/β inhibitors, OX40 ligand costimulatory molecule blockers, and B-cell targeted therapies represent promising approaches for patients with treatment-refractory disease. Janus kinase (JAK) inhibitors from multiple companies are progressing through development with various selectivity profiles, offering oral treatment options with extensive safety databases from use in other inflammatory conditions.

Ongoing basic science research continues uncovering the roles of different immune pathways including IL-1α/β, B-cell switching mechanisms, and various T-cell populations, potentially enabling future biomarker-driven treatment selection. This research may ultimately allow matching specific therapies to individual patient immune profiles or phenotypes, moving beyond trial-and-error approaches toward precision medicine. For the 10% to 15% of patients with most severe disease who remain refractory to current therapies, customized antibody approaches targeting their specific immune abnormalities represent hope for future breakthrough treatments.

Panelists discuss how they monitor patients through early follow-up visits at 1 to 3 months to assess medication access, manage cutaneous adverse effects, check liver function tests, and use educational handouts and pharmacy support to counsel patients on expected benefits vs risks while maintaining treatment adherence.

Monitoring Adverse Effects and Treatment Response of IL-17 Inhibitors in HS

Clinical monitoring protocols for IL-17 inhibitors involve early follow-up visits at 1 to 2 months primarily to confirm medication access, address initial cutaneous adverse effects that may impact adherence, and provide reassurance during the period before therapeutic benefit becomes apparent. The critical 3-month assessment point allows determination of treatment response and need for optimization, whether through dose escalation (for secukinumab from every 4 weeks to every 2 weeks) or consideration of alternative therapies if patients show worsening or inadequate improvement.

Safety monitoring includes liver function testing at 3 months based on current labeling requirements for bimekizumab, with ongoing monitoring until sufficient long-term safety data accumulate. Mental health assessment remains important given rare but significant cases of depression or suicidal ideation, though practitioners emphasize that mental health support benefits all patients with hidradenitis suppurativa (HS) regardless of treatment given the high baseline prevalence of psychological distress. Tuberculosis (TB) screening follows traditional protocols before initiating therapy, though the TB reactivation signal for IL-17 inhibitors appears minimal compared with TNF inhibitors.

Patient education tools include comprehensive handouts covering expected benefits, potential adverse effects, and when to seek medical attention, with modern digital formats using QR codes providing easy access to regularly updated resources with hyperlinks to additional support services. Counseling emphasizes that the most common “side effect” patients will experience is disease improvement, helping to balance safety information with realistic expectations about benefit. Many practices employ pharmacists or pharmacy technicians to conduct standardized counseling, reserving physician time for addressing patient-specific concerns and nuanced clinical decision-making while ensuring consistent, thorough safety education.

Martina Porter, MD

Articles