Predictive Factors of Secukinumab Response in Korean Hidradenitis Suppurativa Patients: Insights from a 48-Week Trial

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by painful nodules, abscesses, and draining tunnels commonly occurring in body folds. The IL-17A inhibitor, secukinumab, has shown efficacy in reducing HS lesions in clinical studies, but data on epidemiologic and patient-specific factors influencing response remain limited. Objectives: To assess how baseline disease severity, treatment initiation delay, and prior biologics exposure influence clinical response to secukinumab and patterns of antibiotic use. Materials and Methods: This 48-week real-world prospective trial enrolled 10 Korean patients with moderate-to-severe HS. Patients received secukinumab 300 mg subcutaneously at weeks 0, 1, 2, 3, and 4, then every two weeks. Outcomes included Hidradenitis Suppurativa Clinical Response (HiSCR), a 55% reduction in the International HS Severity Score System (IHS4-55), mean change in abscesses and inflammatory nodules, a ≥ 30% reduction in pain score on a numeric rating scale (NRS30), and duration of concomitant antibiotic use. Results: At week 48, 90% of patients achieved HiSCR, with 90% meeting the IHS4-55 threshold and 60% reaching the NRS30 criteria. Faster responses were recorded in subjects with Hurley stage II, treatment delays of <10 years, or no prior biologics use, although response rates equalized by week 48. All patients, particularly moderate cases, either discontinued or transitioned to monotherapy with systemic antibiotics. Conclusions: Secukinumab demonstrated efficacy in alleviating HS symptoms in moderate-to-severe cases. Patients with less severe disease, shorter treatment delays, and/or no prior biological therapy exhibited more rapid initial responses. Additionally, the majority of patients experienced a significant duration of antibiotic cessation, underscoring the importance of early intervention. Future studies with larger populations are required to substantiate these findings.