From Tunnels to Treatment: Advancing HS Management - Episode 6
HS Biologics: IL-17 vs TNF Inhibition, Bimekizumab Tunnel Data, and Early Treatment
Pathway biology and new draining tunnel data shape how the panel positions TNF and IL-17 inhibitors. The discussion also makes the case that earlier treatment improves response and preserves functional tissue.
In "HS Biologics: IL-17 vs TNF Inhibition, Bimekizumab Tunnel Data, and Early Treatment," the panel explores how pathway differences and EADV data influence biologic selection and timing.
The panel is asked how TNF-alpha and IL-17 inhibitors differ in the inflammatory pathways they target and how they are used differently in HS. The panel explains that TNF inhibitors offer broader inhibition and are a strong choice with comorbid inflammatory bowel disease, but they require awareness of possible exacerbation of congestive heart failure or links to multiple sclerosis. For patients with draining tunnels, an IL-17 agent, particularly one covering IL-17F, may be preferable because IL-17F is highly enriched in the epithelium lining sinus tracts. Panelists describe favoring TNF inhibitors for nodular phenotypes. The panel adds that growing data suggest meaningful differences among the three biologics.
Attention then turns to bimekizumab data presented at EADV from the BE HEARD studies, which tracked draining tunnel counts over three years. The mean baseline count was roughly 3.8 to 4, and the three-year change was a decrease of more than three. The analyses were also stratified by disease duration and prior biologic use.
That leads to a case for treating earlier. The panel pushes back on reserving biologics for the worst cases, noting that the risks of a drug stay constant while the benefit shrinks over time, so the best risk-benefit ratio comes from early, aggressive treatment. When patients are separated by disease duration, the response rate cited roughly halves, from 46% to 23%, in longer-standing disease. Patients with longer disease still deserve treatment and can improve, but the needle moves more with earlier treatment. The panel suggests the data may support using biologics sooner, in milder disease, and potentially reducing comorbidities. Even when tunnels resolve, scarring remains in functional areas that need soft, pliable tissue, so early aggressive treatment is described as tissue sparing.
In "HS Long-Term Outcomes: Durable Response, Tunnel Regression, and Monitoring," the panel will examine longer-term secukinumab data and how clinicians monitor patients over time.
