Biologic Selection and Comorbidity Screening in HS, With Jennifer Hsiao, MD

Clear expectations, patience before reassessing and gradual comorbidity screening are central to biologic therapy for moderate to severe hidradenitis suppurativa (HS), according to Jennifer L. Hsiao, MD.

Hsiao is a professor of dermatology at the University of Southern California and co-director of an HS specialty clinic. In this on-site interview, she spoke about her approach and other strategies for HS with HCPLive at the 2026 Fall Clinical Dermatology Conference in Las Vegas, Nevada.

What Should Patients Expect When Starting an HS Biologic?

Hsiao tells patients that current therapies are unlikely to resolve established tunnels the way modern agents can clear psoriasis or eczema. Instead, she asks them to track drainage and pain, and whether new lesions appear less often, stay smaller, and resolve sooner. Framing responses this way helps patients recognize a partial benefit and stay on treatment.

She plans a formal reassessment 3 to 4 months after starting a biologic and explains that window at the first visit. Because options are limited, she cautioned against abandoning an agent before it has had enough time to work.

How Do Dermatologists Choose Among Approved HS Biologics?

Adalimumab, secukinumab and bimekizumab are the 3 biologics currently approved by the FDA for HS; bimekizumab was approved in November 2024.³ Hsiao weighs patient age, preferences, comorbidities and insurance coverage when choosing among them. She emphasized starting therapy promptly while a patient is willing, ideally at early moderate disease. Bridge and patient assistance programs can reduce delays in access.

Hsiao welcomed oral Janus kinase (JAK) inhibitors as a needle-free option. They may also suit patients whose disease isn’t driven by a single cytokine. In the phase 3 STOP-HS1 and STOP-HS2 trials, 40% to 42% of patients receiving povorcitinib 45 mg or 75 mg achieved HiSCR50 at week 12, compared with 29% to 30% receiving placebo. Observed HiSCR50 rates reached 57.3% to 71.4% through week 54.¹ Incyte reports that a new drug application for povorcitinib in HS is under FDA review.²

Which Comorbidities Should Be Screened in HS?

Comorbidity screening can take place over several visits, Hsiao said. The physical exam is a chance to check for acne, dissecting cellulitis of the scalp, and pilonidal disease. She advised raising tobacco cessation once rapport is established, framed as a matter of overall health rather than a cause of HS. She also recommended prioritizing questions about inflammatory bowel disease and spondyloarthritis, which affect both long-term health and the choice of biologic.

Editor's Note: This summary was edited for grammar and clarity using artificial intelligence tools. Hsiao has previously disclosed receiving consulting fees from AbbVie, Boehringer Ingelheim, Novartis, and UCB and speaker fees from AbbVie, and serving on the board of directors of the Hidradenitis Suppurativa Foundation.

References

1. Porter ML, Martorell A, Sayed CJ, et al. Povorcitinib for hidradenitis suppurativa: the randomized, double-blind, placebo-controlled STOP-HS1 and STOP-HS2 phase 3 trials. Nat Med. 2026;32(8):3071-3081. doi:10.1038/s41591-026-04534-z.

2. Incyte. Incyte announces new positive 54-week late-breaking data for povorcitinib in hidradenitis suppurativa at the 2026 American Academy of Dermatology (AAD) Annual Meeting. Published March 28, 2026. Accessed October 30, 2026. https://investor.incyte.com/news-releases/news-release-details/incyte-announces-new-positive-54-week-late-breaking-data.

3. Smith T. FDA approves bimekizumab for adults with hidradenitis suppurativa. HCPLive. Published November 20, 2024. Accessed October 30, 2026. https://www.hcplive.com/view/fda-approves-bimekizumab-adults-with-hidradenitis-suppurativa.