Meta-Analysis Compares Hidradenitis Suppurativa Treatments

TOPLINE:

In a network meta-analysis of 25 randomized trials, sonelokimab was ranked highest for treating patients with moderate-to-severe hidradenitis suppurativa (HS). Adalimumab, lutikizumab, and bimekizumab were also ranked high.

METHODOLOGY:

• Researchers conducted a systematic review and network meta-analysis of 25 phase 2 and 3 randomized clinical trials of medical treatments for adults with moderate-to-severe HS (up to June 28, 2024), with primary efficacy assessments performed between 12 and 16 weeks.
• The trials included 5767 patients with moderate-to-severe HS and 39 unique treatments, including the three approved treatments in the US and Europe: adalimumab, secukinumab, and bimekizumab.
• Primary outcomes were the HS Clinical Response of at least 50% (HiSCR-50), serious adverse events, and discontinuation due to adverse events. Researchers also reported HiSCR-75.

TAKEAWAY:

• Compared with placebo, significantly higher HiSCR-50 responses were noted for sonelokimab, 120 mg, every 4 weeks (odds ratio [OR], 4.44; 95% CI, 2.29-8.61) and 240 mg (OR, 2.62; 95% CI, 1.37-5.00); lutikizumab, 300 mg, every 2 weeks (OR, 2.72; 95% CI, 1.08-6.86); adalimumab, 40 mg, once weekly (OR, 2.63; 95% CI, 2.06-3.36); bimekizumab, 320 mg, every 2 weeks (OR, 2.63; 95% CI, 2.06-3.36) and every 4 weeks (OR, 2.27; 95% CI, 1.52-3.39); povorcitinib, 15 mg, once per day (OR, 2.28; 95% CI, 1.02-5.13); and secukinumab, 300 mg, every 2 weeks (OR, 1.60; 95% CI, 1.18-2.16) and every 4 weeks (OR, 1.62; 95% CI, 1.20-2.20).
• Compared with placebo, higher HiSCR-75 responses (a secondary endpoint) were noted for sonelokimab, 120 mg, every 4 weeks (OR, 4.12; 95% CI, 2.00-8.51); lutikizumab, 300 mg, every 2 weeks (OR, 4.01; 95% CI, 1.40-11.47) and once weekly (OR, 2.95; 95% CI, 1.03-8.42); bimekizumab, 320 mg, every 2 weeks (OR, 2.91; 95% CI, 1.89-4.49); sonelokimab, 240 mg, every 4 weeks (OR, 2.89; 1.38-6.06); adalimumab, 40 mg, once per week (OR, 2.85; 95% CI, 1.89-4.30); bimekizumab, 320 mg, every 4 weeks (OR, 2.26; 95% CI, 1.39-3.66); and secukinumab, 300 mg, every 4 weeks (OR, 2.04; 95% CI, 1.39-3.00) and every 2 weeks (OR, 1.85; 95% CI, 1.26-2.73).
• Sonelokimab, 120 mg, every 4 weeks was the top treatment for both HiSCR-50 and HiSCR-75. Other high-rated treatments were adalimumab, 40 mg, once per week; sonelokimab, 240 mg, every 4 weeks; lutikizumab, 300 mg, every 2 weeks; and bimekizumab, 320 mg, every 2 weeks.
• Serious adverse event rates ranged from 0% to 10% for placebo, 0% to 8% for adalimumab (40 mg once per week), and 0% to 6% for other active treatment groups. Discontinuation rates due to adverse events were 0%-10%, 0%-4%, and 0%-15%, respectively.

IN PRACTICE:

The network meta-analysis “provides evidence for the comparative efficacy and safety of currently approved cytokine inhibitors for moderate to severe HS in the absence of head-to-head trials,” the authors of the study wrote. “Phase 2 results for several cytokine and small-molecule treatments are promising and require confirmation in larger phase 3 trials,” they added.

SOURCE:

The study was led by Amit Garg, MD, Department of Dermatology, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York, and was published online on July 2 in JAMA Dermatology.

LIMITATIONS:

Limitations were reliance on indirect evidence for most comparisons, small sample size for individual treatment groups, and short follow-up.

DISCLOSURES:

The authors reported no funding information. Garg declared receiving grants and personal fees from AbbVie, Almirall, Boehringer Ingelheim, Engitix, Immunitas Therapeutics, Incyte, Insmed, Novartis, Pfizer, Priovant Therapeutics, Sonoma Biotherapeutics, Sun Pharma, UCB, UNION Therapeutics, and Zura Bio, and having a patent for an HS Investigator Global Assessment and a licensed patent for HS quality of life.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.