Efficacy of Biologics for Hidradenitis Suppurativa: A Network Meta Analysis and Meta Regression for Baseline Disease Severity

Hidradenitis Suppurativa is a challenging, heterogeneous inflammatory skin disease, with three approved biologic therapies. No head-to-head studies exist comparing these therapeutic modalities, and previous work has identified the influence of baseline disease severity upon clinical response. We aimed to perform a network meta-analysis of approved biologic therapies and meta-regression of baseline disease severity in moderate to severe HS. Pubmed, Embase, and Web of Science were searched from their inception up until 31 July 2025. Randomised Phase 3 clinical trials of biologic therapies approved for use in moderate to severe Hidradenitis Suppurativa. Network meta-analysis was conducted via both frequentist and Bayesian frameworks. Subgroup analysis was performed using a priori identified covariates (baseline AN count, tunnel count, BMI, and smoking), and random effects meta regression was performed with the final model selected using restricted maximum likelihood, I², and Cochran's Q statistic. Adjusted odds ratios were then calculated. Efficacy outcomes analysed were the Hidradenitis Suppurativa Clinical Response (HiSCR-50) score, compared using odds ratios and 95% CI for frequentist analysis and odds ratio and 95% CrI for Bayesian methods. Adalimumab (OR = 2.81 95% CI 2.01-3.92), followed by Bimekizumab q2weekly (OR 2.24, 95% CI 1.52-3.29) had the highest odds of HiSCR50 clinical response compared to placebo. Baseline tunnel count was the only significant covariate influencing odds of response (OR = 0.225, 95% CI = 0.013-0.436, p = 0.0375), with meta-regression and adjusted odds ratios accounting for baseline tunnels demonstrating an increase in the odds of clinical response to Adalimumab and Bimekizumab, whilst the odds of achieving clinical response to Secukinumab became non-significant relative to placebo.