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

Martina Porter, MD

Future Research, Opportunities in Hidradenitis Suppurativa

In the final installment of this HCPLive News Network, Martina Porter, MD, a dermatologist at Beth Israel Deaconess Medical Center, and Colleen Cotton, MD, a dermatologist with National Children's Hospital, delve into the recent approval of bimekizumab (Bimzelx) for treating hidradenitis suppurativa (HS) and the broader landscape of HS management, including emerging treatment options, dosing considerations, and practical clinical insights.

Adolescent and Early Treatment Considerations

Cotton emphasizes the excitement surrounding ongoing clinical trials focused on adolescents with HS, an age group where over half of patients report the onset of symptoms. She highlights the importance of early intervention, as aggressive treatment can significantly improve long-term outcomes for patients. Unlike psoriasis or atopic dermatitis, where delayed treatment doesn’t necessarily hinder disease management, HS is progressive, making early and aggressive treatment crucial to preventing irreversible damage and scarring.

Porter adds that while biologics can lead to skin normalization in conditions like severe psoriasis or eczema, HS patients often experience persistent symptoms such as itching and scarring even when their inflammatory burden is controlled. This highlights the ongoing need for early and sustained treatment strategies in HS management. She also underscores the growing pipeline of treatments, providing hope for future improvements in disease control and patient quality of life.

Combination Therapy and Clinical Practice Considerations

Both experts recognize the potential benefits of combining therapies in real-world settings, which are not typically explored in clinical trials. Porter mentions that patients might benefit from adjunct therapies—such as interlesional steroid injections—while awaiting the full effects of biologic treatments. Cotton agrees, emphasizing that dual therapies and managing comorbidities like blood glucose control will be integral to optimizing patient care.

A critical point raised by Cotton pertains to dosing discrepancies between HS and psoriasis treatments with the same biologics. She explains that HS dosing, typically higher and more frequent, differs from psoriasis regimens and stresses the importance of ensuring that patients receive the correct dosing to maximize efficacy. She also notes that insurance challenges often arise when transitioning from the loading phase to maintenance dosing, a problem that could be mitigated by the extended 16-week loading dose period for bimekizumab.

The conversation concludes with both experts expressing optimism about the future of HS treatments. While they anticipate some challenges in getting the optimal dose for certain patients, the introduction of bimekizumab as a new option brings renewed hope to clinicians and patients alike. With multiple therapies now available, dermatologists have more flexibility to tailor treatments based on individual patient needs, improving the overall outlook for those living with HS.

Relevant disclosures for Porter include Abbvie, Bristol Myers Squibb, Janssen, Eli Lilly, Novartis, Pfizer, UCB, Trifecta Clinical, Incyte, and Anaptys Bio. Relevant disclosures for Cotton include Leo Pharma, Novartis, Avita Medical, and others.

Videos

The recent approval of bimekizumab for hidradenitis suppurativa (HS) marks a significant advancement in HS management, emphasizing the importance of early and aggressive treatment, especially in adolescents. Early intervention is crucial to prevent irreversible damage and scarring. Combination therapies, including adjunct treatments, are beneficial in real-world settings. Dosing discrepancies between HS and psoriasis treatments highlight the need for correct dosing to maximize efficacy. The introduction of bimekizumab offers renewed hope, providing dermatologists with more flexibility to tailor treatments to individual patient needs, improving outcomes for those with HS.

In the fifth and final video from this series, experts discuss future research priorities and opportunities in hidradenitis suppurativa. 

Safety Profile of Bimekizumab in Hidradenitis Suppurativa

In part 4 of our 5-part series, Martina Porter, MD, a dermatologist at Beth Israel Deaconess Medical Center, and Colleen Cotton, MD, a dermatologist with National Children's Hospital, provide a detailed overview of the safety profile of bimekizumab (Bimzelx), emphasizing its implications for patients with hidradenitis suppurativa (HS), particularly those with coexisting inflammatory bowel disease (IBD) or other safety concerns associated with IL-17 inhibitors.

Porter highlights promising findings regarding IBD in the bimekizumab trials. Patients with a history of IBD were allowed to participate if their condition was inactive and untreated prior to the study. Among this subset, no significant reactivation of IBD was observed, which is reassuring, particularly for pediatric patients who might be at risk for unmasking IBD. A small percentage of trial participants did develop mild symptoms leading to an IBD diagnosis; however, these cases were non-severe and consistent with the expected incidence for HS populations. While bimekizumab remains unsuitable for patients with active IBD, these findings suggest it may be a safe option for those with a stable history of the condition.

Both experts address candidiasis, a known risk associated with IL-17 inhibitors, with bimekizumab showing a slightly higher incidence compared to IL-17A inhibitors. Most cases of candidiasis in the trials were mild, typically manifesting as oral thrush or vulvovaginal infections, and were easily managed with standard antifungal treatments. Porter notes that candidiasis generally occurs early in the course of therapy and is less likely to recur with continued treatment, a reassuring trend for long-term use.

Cotton introduces the FDA warning about suicidality and suicide attempts associated with bimekizumab, derived from psoriasis trials rather than HS studies. She underscores the importance of discussing this potential risk with patients while contextualizing it within the broader mental health challenges faced by patients with severe skin diseases, including high rates of anxiety and depression. Porter references recent studies comparing suicidality across biologics for psoriasis, noting that bimekizumab’s risk appears comparable to other therapies and must be considered in the context of the underlying psychiatric comorbidities in this population.

Both physicians agree on the critical need for open communication with patients about these risks. Clear discussions can help manage expectations, particularly regarding FDA warnings on package inserts, and reinforce the importance of monitoring mental health during treatment. Despite these considerations, bimekizumab remains an important therapeutic option, offering hope for better disease control in a challenging condition like HS.

Bimekizumab (Bimzelx) shows promise for hidradenitis suppurativa (HS) patients, especially those with inactive inflammatory bowel disease (IBD), as trials indicate no significant IBD reactivation. While candidiasis incidence is slightly higher compared to IL-17A inhibitors, cases are mild and manageable. Concerns about suicidality, based on psoriasis trials, necessitate patient discussions, considering the mental health challenges in severe skin diseases. Open communication about risks and FDA warnings is crucial. Despite these concerns, bimekizumab remains a valuable option for HS management, offering potential for improved disease control.

In part 4 of our series, expert dermatologists discuss the safety profile of bimekizumab in HS relative to other disease states and trials. 

Strengths, Limitations of IL-17 A/F Inhibition in Hidradenitis Suppurativa

In this segment of our 5-part video series, Martina Porter, MD, a dermatologist at Beth Israel Deaconess Medical Center, and Colleen Cotton, MD, a dermatologist with National Children's Hospital, explore the advantages and limitations of using bimekizumab as an alternative therapy for patients with hidradenitis suppurativa (HS) who fail or lose response to other biologics. Their discussion highlights the clinical promise of this newly approved treatment while acknowledging practical and patient-specific challenges.

Cotton emphasizes that one of the key advantages of bimekizumab is simply its availability, offering patients a novel mechanism of action with dual inhibition of IL-17A and IL-17F. This differentiates it from existing options, such as TNF-alpha inhibitors, and may renew hope for patients who have not responded to previous therapies. However, she points out that significant limitations remain, particularly for pediatric patients under 18. Insurance barriers make it exceedingly difficult to secure off-label coverage, even in cases with supportive safety data.

Cotton also raises concerns regarding the potential overlap of HS and inflammatory bowel disease (IBD), such as Crohn’s disease and ulcerative colitis. Because IL-17 inhibitors can exacerbate IBD, bimekizumab is not a suitable option for patients with active IBD who have failed other biologics. This underscores the need for a nuanced approach to treatment selection based on individual patient profiles.

Porter concurs, recognizing that while bimekizumab expands the therapeutic landscape for HS, careful consideration of patient-specific factors, such as age and comorbidities, remains essential.

In this video series segment, expert dermatologsts prove ide insight into the strengths and limitations of IL-17 A/F inhibition in HS.

Understanding, Leveraging IL-17 A/F with Bimekizumab in HS

Understanding, Leveraging IL-17 A/F Inhibition with Bimekizumab in HS

In the second of this 5-part video series, delve into the unique mechanism of action of bimekizumab, which inhibits both IL-17A and IL-17F, and discuss how this dual inhibition may compare to other biologic therapies targeting single inflammatory pathways in hidradenitis suppurativa (HS). The conversation highlights the complexity of HS pathogenesis and the evolving understanding of its immunologic drivers.

Porter frames the discussion by addressing the unclear contributions of IL-17A, IL-17F, and TNF-alpha in HS. She notes that while IL-17A and TNF-alpha inhibitors have shown efficacy in some patients, there is variability in response, leaving an unmet need for therapies targeting broader inflammatory pathways. She points out that patients who fail monotherapy targeting IL-17A may benefit from dual inhibition with bimekizumab, though real-world data will be crucial in determining its relative advantage.

Cotton underscores the potential of dual inhibition, comparing bimekizumab with another IL-17A/F inhibitor, sonelokimab, currently in development. She highlights the promising phase 2 data for sonelokimab, which achieved the highest efficacy endpoint to date in HS trials, with about 50% of patients reaching HiSCR75. According to Cotton, this benchmark raises hopes for greater therapeutic success in a disease where response rates have lagged behind those seen in psoriasis or atopic dermatitis.

Expert dermatologists discuss the role of IL-17 A/F inhibition in the management of hidradenitis suppurativa. 

Martina Porter, MD

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