HS Specialists Express Support for Earlier Use of Biologics Among Patients

Hidradenitis suppurativa (HS) specialists commonly believe antibiotic-first requirements for patients are outdated and often ineffective, new data suggest, and they support earlier use of biologics to improve outcomes.1

These findings resulted from a questionnaire administered to 55 specialists in HS treatment, and the analysis of these data was authored by investigators such as Georgios Nikolakis, MD, PhD, of Brandenburg Medical School Theodor Fontane (MHB). Nikolakis and colleagues noted first-line biologic medications, as well as their potential advantages both for patients' health outcomes and long-term sustainability, required exploration.

Prior to this survey and analysis, they also highlighted the importance of examining the utilization of antibiotics in patients who are likely to switch to biologics, especially in light of antibiotic resistance and its worldwide growth.2

“To address this, we sought insights from selected physicians, the majority of whom have been associated with the European Hidradenitis Suppurativa Foundation (EHSF), who possess specialized knowledge and experience with HS,” Nikolakis et al wrote.1 “Our objective was to better define their systemic therapy strategies and identify potential unmet needs in the prescription of antibiotics and biologics in their clinical practice.”

Design and Survey Findings

The investigative team provided an electronic survey to 55 HS specialists on July 20, 2024. Most of these individuals were also noted members of the European Hidradenitis Suppurativa Foundation (EHSF). The survey, submitted via Google Forms, requested its recipients to fill out the questionnaire within 40 days. The team's survey invitations were emailed to addresses provided by members upon their taking part in the EHSF. They involved clinicians from all countries in Europe to ensure broad geographic representation.

Those taking part as participants were categorized by Nikolakis and coauthors as either HS experts or future opinion leaders. Those specifically labeled as HS experts were defined as physicians who were over the age of 40 years with extensive clinical experience in HS management, a history of frequent peer-reviewed publications, and/or involvement in national or international clinical guidelines. Often, those taking part had held leadership roles in professional societies, had organized HS-focused workshops, or had contributed to large-scale educational initiatives aimed at advancing care for HS.

Those classified by the investigators as future opinion leaders were identified as clinicians typically under the age of 40 years who had actively engaged in emerging HS research. These subjects' involvement was demonstrated through recent poster presentations, first- or co-authored publications, or active participation in national or international HS congresses within the prior 3 years. The ages of both types of participants were reported by Nikolakis et al as mean ± SD, with statistical analyses being carried out via Jamovi Version 2.6.25.0.

There were 16 questions provided in this survey, with the investigative team seeking to assess systemic treatment prescribing patterns in HS, the real-world application of clinical guidelines, and any existing unmet needs in biologic prescriptions. Additionally, those involved as subjects were asked to provide 3 illustrative cases where they would consider initiating biologic treatment, either as monotherapy or alongside antibiotics, without following the previously required 3-month antibiotic course.

Among those invited as respondents, 23 out of 30 experts (77%) and 20 out of 25 future opinion leaders (80%) filled out the survey. This resulted in a total of 43 individuals taking part, representing 19 of the 22 invited European countries. Among those in the expert cohort, 39% were listed as female, compared with 55% of those in the future opinion leader cohort. These respondents' mean ages were 55.4 ± 7.8 years for the expert group and 36.5 ± 4.88 years in the future leader group (P < .001).

In their evaluation of practice patterns, the team found adherence among 95% of respondents to licensing regulations recommending 10–12 weeks of antibiotics prior to the initiation of biologics. However, they also highlighted 81% who confessed to prescribing antibiotics despite anticipating insufficient response. Over half of the those responding to the investigators' survey reported patients' experiences of disease flares during antibiotic therapy.

Nikolakis and colleagues also found 77% supported initiating biologic drugs earlier in cases of persistent flares. They also noted 79% who preferred short-term biologic therapy over antibiotics for early-stage HS. Those included in the study highlighted specific clinical features, including rapidly progressing disease, comorbidities, and extensive involvement, as justifications for earlier biologic use.

“The findings underscore the need for a consensus statement defining upgrade criteria for biologics as a first-line therapy, potentially improving patient outcomes and reducing healthcare burdens,” they concluded.1

References

1. Nikolakis G, Alpsoy E, Zouboulis CC, et al. Towards the development of upgrade criteria for the treatment of hidradenitis suppurativa with biologics. J Eur Acad Dermatol Venereol. 2025 Nov 13. doi: 10.1111/jdv.70118. Epub ahead of print. PMID: 41230814.

2. Aggarwal R, Mahajan P, Johri AK, et al. Antibiotic resistance: a global crisis, problems and solutions. Crit Rev Microbiol. 2024 Sep;50(5):896-921. doi: 10.1080/1040841X.2024.2313024. Epub 2024 Feb 21. PMID: 38381581.