Q&A: Comorbidity Screening and Biologic Timing in HS, With Jennifer Hsiao, MD

Dermatologists treating moderate to severe hidradenitis suppurativa (HS) now have 3 US Food and Drug Administration (FDA)-approved biologics, with bimekizumab joining adalimumab and secukinumab in November 2024 as the first dual IL-17A and IL-17F inhibitor for the disease.³ All 3 are injectable agents targeting either tumor necrosis factor-α or IL-17 signaling, and oral Janus kinase (JAK) inhibition is now the mechanism closest to joining them.

In the phase 3 STOP-HS1 trial, 40% [82/204] and 41% [82/202] of patients receiving povorcitinib 45 mg and 75 mg achieved HiSCR50 at week 12, vs 30% [60/202] with placebo (P = .0240; P = .0214).¹ In STOP-HS2, published alongside STOP-HS1 in Nature Medicine, 42% of patients at both doses [88/208 each] reached HiSCR50 vs 29% [58/203] with placebo (P = .0035; P = .0033).¹ Through week 54, observed HiSCR50 rates ranged from 57.3% to 71.4%, and HiSCR75 rates ranged from 39.0% - 57.0%.¹

Serious adverse events occurred in 5% of patients receiving 45 mg and 6% receiving 75 mg, with acne, nasopharyngitis, and upper respiratory tract infection reported most frequently.¹ According to Incyte, a new drug application for povorcitinib in HS is under FDA review.² Agent selection is only 1 part of HS management, as expectation setting, reassessment timing, and screening for comorbidities such as inflammatory bowel disease and spondyloarthritis shape day-to-day care.

Jennifer L. Hsiao, MD, professor of dermatology at the University of Southern California and co-director of an HS specialty clinic, addressed both topics in 2 presentations, 1 alongside Iltefat Hamzavi, MD. In the following interview, Hsiao spoke with the HCPLive team at the 2026 Fall Clinical Dermatology Conference in Las Vegas about defining treatment success, choosing among biologics, and where oral JAK inhibitors may fit:

HCPLive: When you start a patient with HS on a biologic, how do you define and communicate what success looks like?

Jennifer Hsiao, MD: I think it's really important to set treatment expectations for our patients with HS. We're not quite where we are with psoriasis or eczema, where oftentimes you start a medication and the skin can just clear as if nothing was ever there before. Where we are currently, we're not really expecting medications to melt tunnels away, so it's really important to let patients know what to look for. We're trying to reduce active inflammation and the symptoms associated with it.

What I'll tell patients is, the next time you come back, I want you to report on less drainage and less pain. If you get new lesions, hopefully there are fewer of them, they're smaller, and they go away faster. That really speaks to reduced flare frequency, and also reduced flare severity and duration.

It really makes a big difference, because when patients come back, they can assess and tell me, "Yeah, I got a few new lesions, but they were smaller and went away faster, so the medication might be working for me," versus, "I don't think this medication is working at all, because why am I still getting new spots?" So treatment expectation setting is really important for treatment adherence.

HCPLive: Of the currently approved biologics, how do you decide which to start and when to switch?

Jennifer Hsiao, MD: We're really fortunate to have 3 FDA-approved therapies right now. We have adalimumab, a TNF-α inhibitor; secukinumab, an IL-17A inhibitor; and bimekizumab, our IL-17A and IL-17F inhibitor. At this point, adalimumab and secukinumab are approved for patients 12 and up, so in terms of age range, that helps us with treatment selection as well.

Honestly, at this point in time, I think about patient preferences. A patient may come in and say, "I've heard this about this medication. There's absolutely no way I'm going to start that." Taking in what patients have heard is also very important, because if you have options and there's one they're vehemently opposed to for some reason, you may not want to push at that visit. Patient comorbidities also play a role, and ultimately, access plays a role.

If a patient is interested and willing to start a medication, I really want to get a medication into that patient's hands as soon as possible. I feel like with delays, patients may say, "You know what, this is more trouble than it's worth," and you might miss a window of time when they were open to starting therapy. That's where insurance formularies often come in, and I think having strong bridge and patient assistance programs can be helpful. But ultimately, our goal should be identifying that patient during that window of opportunity, hopefully when they have early moderate disease, starting one of the 3 we have, and hopefully being able to start mitigating disease progression, or at least helping them feel better now.

HCPLive: How long do you give a therapy before deciding it isn't working, and how do you discuss that timeline with patients?

Jennifer Hsiao, MD: These are not medications where patients can expect it to be like an infection, where you take an antibiotic for a week and the infection clears. With HS, we really emphasize there's a lot of inflammation we need to get under control. So I'm looking at a timeline where we reassess in 3 to 4 months, and you have to set that from the start. This way, patients will be able to stay on therapy even if it takes a little bit longer to work.

We have a limited number of therapies, and patients are aware of this. They understand the concept of not wanting to just run through the treatments that are available. You don't want to miss out on one where maybe they could ultimately achieve a good response, but you just didn't hang in there long enough.

HCPLive: Where do you see oral JAK inhibitors fitting into the HS treatment landscape?

Jennifer Hsiao, MD: Honestly, at this time, anything that can get FDA approval with good efficacy and safety, we'll take it. All treatments that can demonstrate this are welcome. I think part of that is because HS is heterogeneous in terms of its pathophysiology. There could be some patients who are great IL-17 responders but not TNF responders, or vice versa, and some who don't respond adequately to either.

When I think about the JAK inhibitors, number 1, I'm glad we'll have an oral option. There are still some patients who are needle averse, so it's nice to be able to offer a different mode of delivery. Then there are those patients I mentioned, where maybe their HS pathophysiology isn't dominated by 1 cytokine and is more heterogeneous. Being able to impact a larger number of cytokines by inhibiting a signaling pathway like the JAK-STAT pathway may be helpful for those patients.

So absolutely, I think we just need more treatments in our toolkit, and it's exciting that we have medications on the horizon. I think JAK inhibitors are probably furthest along, with povorcitinib, a JAK1-selective inhibitor, recently publishing a paper with efficacy and safety data through 54 weeks. It would be really exciting to be able to access these medications when they're approved.

HCPLive: Which comorbidities should every dermatologist screen for in patients with HS, and what does a realistic workflow look like?

Jennifer Hsiao, MD: I think the first thing to say is that we don't need to do everything at the first visit. The first visit can be daunting. The patient needs to share their story with you, and at the same time, as the clinician, you're trying to digest where the patient's coming from and what stage they're at, and build a treatment plan. So comorbidity screening can really take place during your examination of the patient, too.

For the cutaneous comorbidities, look for signs of acne and check their scalp. Do they have dissecting cellulitis of the scalp? You likely need to look at the groin and buttock areas, which are also areas HS commonly affects, so do they have a pilonidal cyst? You can knock out those cutaneous comorbidities during your physical exam. You can also ask questions about them: Do you have lesions on the scalp? Do you have lesions in the buttock area?

For the other comorbidities patients have, you can enlist a primary care provider to help with a lot of those. On the derm side, I think tobacco smoking is one where we can make a difference, and it doesn't need to be brought up during that first visit as, "You need to quit smoking." It can be brought up during a later visit, when you've established rapport with the patient, and you also make it clear you're really doing this from an overall health perspective. You're not focusing on smoking because you think their smoking caused their HS, or that they're in any way to blame for their HS. I think that's really important as well.

For inflammatory comorbidities, I'd really focus on inflammatory bowel disease and spondyloarthritis. Those are 2 where you can make a big impact on the patient's overall health, and they also impact treatment selection for HS. So I think those would be the 2 to focus on, with easy screening questions you can get through in your regular clinic visit.

HCPLive: Is there any work you're doing or any upcoming events you'd like to highlight?

Jennifer Hsiao, MD: I just want to give a shout-out to the HS Foundation. It's a wonderful organization that really seeks to move education, awareness, and research forward, and we have a conference coming up, the Symposium on Hidradenitis Suppurativa Advances. It's going to be in Tucson in November, and we'd love to see you there.

Also, for any residents out there, every year we host an HS Academy, where our goal is really to equip residents with all of the medical tools and procedural tools, but also a more in-depth understanding of HS, especially if, for example, their program may not have a dedicated HS clinic. So I wanted people to be aware of those 2 upcoming events.

Editor's Note: This transcript has been edited for grammar and clarity using artificial intelligence tools. Hsiao has 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 11, 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 11, 2026. https://www.hcplive.com/view/fda-approves-bimekizumab-adults-with-hidradenitis-suppurativa.