From Tunnels to Treatment: Advancing HS Management - Episode 7
HS Long-Term Outcomes: Durable Response, Tunnel Regression, and Monitoring
Long-term trial and real-world experience suggest tunnel responses can be durable, and even regress in some patients. The panel describes how patient-defined success and follow-up cadence guide decisions to continue or escalate therapy.
This episode, "HS Long-Term Outcomes: Durable Response, Tunnel Regression, and Monitoring," features the panel reviewing long-term draining tunnel data and day-to-day monitoring decisions.
The discussion moves to long-term tunnel data for secukinumab, with the caution that cross-trial comparison is difficult because baseline severity and tunnel counts differ. In the secukinumab trial, baseline draining tunnel count was about 2.4 in both the every-two-week and every-four-week groups. Counts fell by roughly 1.3 to 1.6 by week 52 and then remained stable through week 104. The panel is asked whether clinicians see this durability in practice. The panel says the trial results are mirrored in the real world. The inflammatory milieu in the draining tunnel microenvironment is heavily IL-17 driven, so correct blockade early on stabilizes progression. At annual or six-month visits, patients often need neither escalation nor a change of therapy.
The panel also reports emerging data on regression of draining tunnels, something considered impossible five years ago. One clinician with long trial experience has patients treated for more than five years. Some early Hurley stage 2 patients who started IL-17 inhibitors now look almost as if they do not have HS. The panel suggests earlier, more hesitant patients may benefit more than later-stage ones.
The panel is then asked when clinicians monitor, optimize, or change therapy, and whether they leave patients on a drug for a long time. The panel defines success through the patient's eyes. If patient-reported outcomes show success, therapy continues, and escalation happens only when the clinician believes better is achievable and the patient wants it. Frequent early visits build trust and teach patients to call when they flare. After roughly six months of stability, follow-up intervals can widen. Visits address symptoms and existing structural damage, and one clinician asks patients to point a metaphorical magic finger at what bothers them most, which may identify a spot for surgery.
Up next, in "HS Treatment Access Gaps and the Emerging Therapeutic Pipeline," the experts address insurance-related interruptions and the therapies on the horizon.
