Treatment Patterns of Biologic Therapy in Hidradenitis Suppurativa: A Real-World Claims Analysis

Introduction: Biologic therapies are increasingly used for the management of moderate to severe hidradenitis suppurativa (HS). However, real-world evidence on treatment patterns remains limited. This study evaluated treatment patterns, including adherence, discontinuation, switching, augmentation, and persistence, among patients with HS initiating biologic therapy in the United States.Methods: This retrospective cohort study used IQVIA PharMetrics® Plus claims data. Adults (≥18 years) with ≥2 outpatient or ≥1 inpatient HS diagnosis who first initiated adalimumab or secukinumab between January 2017 and October 2024 and had ≥12 months of continuous enrollment before and after the index date (first biologic use) were included. Treatment patterns were assessed over the 12-month post-index period and included regimen type (monotherapy vs combination therapy), number of fills, days’ supply, adherence (proportion of days covered [PDC]), discontinuation, switching, augmentation (excluding continuation of baseline concomitant therapy), and persistence. Time-to-event outcomes were evaluated using Kaplan-Meier methods. Subgroup analyses were conducted by individual biologic agent.Results: Among 4167 patients (mean age, 37.9 years; 75.4% female), 91.6% initiated adalimumab and 8.4% secukinumab. Most patients initiated biologic therapy as monotherapy (81.1%), whereas 18.9% received combination therapy. During follow-up, patients had a mean of 8.95 fills and approximately 269 total days’ supply; mean PDC, which adjusts for overlapping days’ supply, was 0.61, with 39.0% of patients achieving PDC ≥0.80. Overall, 58.4% discontinued index biologic therapy within 12 months. Kaplan-Meier–estimated median time to discontinuation in the full cohort was 245 days. Among patients who discontinued index therapy, 8.3% switched biologics, and 71.8% subsequently received non-biologic systemic therapies; non-mutually exclusive categories included antibiotics (36.9%), corticosteroids (28.8%), and hormonal therapies (26.3%). Additionally, 70.3% had treatment augmentation before discontinuation. Concomitant opioid use remained relatively unchanged from baseline to follow-up (36.3% vs 35.0%). Among persistent patients, 93.1% had treatment augmentation during follow-up, with a median time to augmentation of 29 days. These descriptive treatment-pattern findings were generally similar across biologic subgroups, although the secukinumab subgroup was substantially smaller.Conclusions: In these real-world claims analyses, patients with HS initiating biologic therapy demonstrated suboptimal adherence and persistence, with high rates of discontinuation and treatment augmentation during the 12-month follow-up. Among patients who discontinued their index biologic, subsequent use of non-biologic systemic therapies was common, whereas switching to another biologic was infrequent. These findings demonstrate substantial treatment modification and limited persistence with biologics in routine clinical practice and highlight the complexity of longitudinal treatment in HS. Additional therapeutic options may help address unmet needs across the HS treatment pathway.