Dual Targeted Therapy for Hidradenitis Suppurativa: A Narrative Review

Area of Science:

• Dermatology and Immunology
• Inflammatory and Immune-Mediated Diseases

Background:

• Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition with significant patient burden.
• Current therapies targeting tumor necrosis factor-alpha (TNF-α) and interleukin-17 (IL-17) benefit many, but some patients remain refractory or lose response.
• Multiple inflammatory pathways, including TNF-α, IL-1, IL-17, and Janus kinase/signal transducer and activator of transcription (JAK/STAT), are concurrently activated in HS.

Purpose of the Study:

• To review the current evidence for dual targeted therapy (DTT) in HS.
• To contextualize HS DTT findings with data from other immune-mediated diseases.
• To explore the potential of DTT for treatment-resistant HS.

Main Methods:

• Narrative review of published literature.
• Analysis of HS-specific case reports on dual biologic or biologic plus Janus kinase (JAK) inhibitor therapy.
• Comparison with DTT data from inflammatory bowel disease, psoriasis, psoriatic arthritis, and rheumatoid arthritis.

Main Results:

• Limited HS-specific reports exist, primarily case reports of DTT.
• Reported DTT in HS showed clinical improvement without serious short-term adverse events.
• Data from related diseases suggest DTT can enhance efficacy with acceptable safety.

Conclusions:

• Dual targeted therapy is a potential strategy for managing treatment-resistant HS.
• Further prospective studies are needed to determine optimal DTT combinations, safety, and long-term outcomes.
• DTT warrants further investigation for improving HS management.