Q&A: Rethinking Early Systemic Therapy for Hidradenitis Suppurativa

Diagnostic delay remains common in hidradenitis suppurativa (HS), and many clinicians hesitate to escalate to systemic therapy once disease has been present for years, assuming limited benefit at an advanced stage.¹ New quartile data from the BE HEARD extension program directly address this assumption using pooled clinical trial results.²

Raj Chovatiya, MD, PhD, MSCI, is clinical associate professor of medicine at Rosalind Franklin University Chicago Medical School and founder and director of the Center for Medical Dermatology + Immunology Research in Chicago, Illinois. He co-authored the analysis, which pooled 2-year data from the phase 3 BE HEARD I and BE HEARD II trials and their open-label extension, BE HEARD EXT.²

Patients diagnosed less than 2.38 years earlier and patients diagnosed 10.74 years or more earlier both achieved meaningful clinical response with bimekizumab, though response rates were consistently higher in the shorter-duration group at stringent thresholds.² At Week 96, IHS4-90 response reached 59.1% (68/115) in the shortest-duration quartile, versus 39.6% (40/101) in the longest-duration quartile, a gap Chovatiya says reinforces the case for earlier intervention.²

These findings support earlier initiation of systemic therapy rather than reserving it for patients with longstanding, treatment-refractory disease.² Diagnostic delay, inconsistent severity grading, and undertreatment remain persistent barriers to timely HS care.¹ Chovatiya argues the data reinforce the case for discussing systemic therapy soon after diagnosis, regardless of how advanced a patient's disease appears.

In the following Q&A interview, Chovatiya discusses the clinical implications of these findings, ongoing unmet needs in HS, and where he hopes the treatment landscape moves next:

HCPLive: What do these findings suggest about the potential benefits of earlier intervention with bimekizumab in HS?

Chovatiya: I can summarize it pretty quickly. We know that many of our epidemiological studies are biased toward people who've had disease a long time, and one of the reasons our outcomes aren't as robust as we'd like may simply be that patients have progressed so far down this inflammatory cascade. We should be treating patients with moderate to severe disease optimally with systemic therapy no matter what, but we need to be more open to treating patients at an earlier stage, since this data and other emerging evidence suggest we might achieve even better response overall. I'd really encourage clinicians to think hard about having a systemic therapy discussion early, as soon as HS patients begin establishing care.

HCPLive: Looking at the data as a whole, what is the key takeaway for clinicians deciding when to consider bimekizumab?

Chovatiya: If you can diagnose HS and patients aren't achieving their goals, you can treat it and move someone up to systemic therapy. These data suggest that even though many clinicians feel hesitant to treat HS once it's advanced, assuming there won't be much improvement, this argues quite the contrary. Whether patients have had disease for a short time or a long time, there can definitely be efficacy achieved with a targeted treatment option like bimekizumab. The earlier you treat, the further you may be able to push those outcomes.

HCPLive: What unmet needs still exist in HS care?

Chovatiya: We know there's a diagnostic delay and treatment delay, and variability in how severity is graded, along with overall undertreatment of this population. This is just another piece of evidence in our cadre suggesting that having that discussion and getting patients on appropriate, advanced, targeted therapy can make a world of difference.

HCPLive: What do you hope to see in future treatment approvals for HS, whether bimekizumab or otherwise?

Chovatiya: It's a very active space for new therapies, and I'm looking forward to seeing what the next decade holds. More importantly, asking important questions like this from data sets is something many sponsors should look to, teasing out concepts like disease duration, disease severity, and other sociodemographic factors, so we can have appropriate predictive factors that let us not only choose the right therapy, but tell us when to intervene.

Editor's Note: This transcript has been edited for grammar and clarity using artificial intelligence tools.

References

1. Saunte DM, Boer J, Stratigos A, et al. Diagnostic delay in hidradenitis suppurativa is a global problem. Br J Dermatol. 2015;173(6):1546-1549.

2. Chovatiya R, Alavi A, Miyagawa T, et al. Bimekizumab 2-year efficacy by hidradenitis suppurativa duration: BE HEARD EXT results. J Eur Acad Dermatol Venereol. 2026. doi:10.1111/jdv.70631.