Beyond Route Preference: Patients With Hidradenitis Suppurativa Want Comparable Oral Options in the Treatment Conversation

Introduction: Treatment selection in hidradenitis suppurativa (HS) requires balancing efficacy and safety with treatment burden and patient preferences. Oral therapies are often viewed as alternatives for patients who prefer pills or wish to avoid injections; however, route preference may underestimate the value patients place on having a clinically comparable oral option available. We analyzed the relationship between stated route-of-administration preference and interest in a clinically comparable oral treatment among adults with HS.Methods: CHOICE-HS was a cross-sectional survey of 210 adults with self-reported HS. Respondents identified important treatment attributes and route-of-administration preference. They were then asked about the likelihood of requesting a switch from a recommended monthly injectable biologic to daily oral therapy, as well as the importance of having a comparable oral option available, assuming comparable efficacy and safety between the oral therapy and injectable biologic.Results: Among 210 respondents, 70% reported moderate or severe HS, and 40% had prior biologic experience. The most reported treatment priorities were fewer abscesses/nodules (94%), long-term safety (79%), pain reduction (76%), and route of administration (28%). When considering route alone, 35% (73/210; 95% CI, 29%–41%) preferred a daily oral pill, 41% (86/210; 95% CI, 35%–48%) a monthly injectable biologic, and 24% (51/210; 95% CI, 19%–31%) reported no preference. However, when efficacy and safety were assumed comparable, 56% (118/210; 95% CI, 49%–63%) reported they would likely/very-likely ask their healthcare provider about switching to an oral therapy, and 52% (109/210; 95% CI, 45%–59%) considered availability of a comparable oral option as highly important. Openness to oral therapy increased with disease severity: of 174 respondents with available Hurley stage data, 30% (8/27) with stage I, 53% (42/79) with stage II, and 65% (44/68) with stage III would likely/very-likely ask about switching. Among respondents currently receiving a monthly injectable biologic, 66% (40/61) would likely/very-likely ask about switching to a comparable oral option, despite only 25% initially stating a preference for oral therapy. The value of oral treatment extended beyond needle avoidance. Among respondents who considered oral treatment availability highly important, leading reasons included avoiding injection reactions (55%), convenience (52%), avoiding needles (51%), pain concerns (39%), and office visit burden (34%), highlighting multiple dimensions of treatment burden associated with injectable therapy.Conclusions: Stated route preference did not fully capture patients’ treatment priorities in HS. When efficacy and safety were assumed comparable, more than half of respondents expressed interest in discussing a switch to oral therapy, including many who did not initially prefer an oral route. This discordance was greatest among patients with greater disease severity and those currently receiving biologics. These findings challenge the notion that oral therapy should be reserved primarily for patients who initially request a pill or wish to avoid needles. Clinically comparable oral therapies should be incorporated into shared decision making across the HS treatment journey, particularly in patients with substantial disease burden and/or prior biologic experience. Optimizing HS treatment requires consideration of both disease burden and the burden imposed by treatment itself.