Efficacy and safety of two interleukin-17 inhibitors (bimekizumab and secukinumab) in the management of hidradenitis suppurativa: a systematic review and meta-analysis of randomized controlled trials

Background Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that primarily affects the intertriginous regions, causing manifestations such as inflammatory nodules, abscesses and scarring. Objectives To systematically evaluate the efficacy and safety of interleukin (IL)-17 inhibitors, including bimekizumab and secukinumab, for the treatment of moderate-to-severe HS based on evidence from randomized controlled trials (RCTs). Methods We searched various electronic databases, including MEDLINE (via PubMed), Embase and CENTRAL to retrieve RCTs on the use of two IL-17 inhibitors (bimekizumab and secukinumab) for the management of HS. Dichotomous outcomes were reported as relative risk (RR) with 95% confidence intervals (CIs), and continuous outcomes were reported as mean difference (MD) with 95% CIs. Results Our meta-analysis included 5 RCTs with a total of 2188 patients. According to our analysis, IL-17 inhibitors significantly increased the proportion of patients with HiSCR50 (Hidradenitis Suppurativa Clinical Response) (RR 1.45, 95% CI 1.26–1.66) and HiSCR75 (RR 2.03, 95% CI 1.42–2.90). IL-17 inhibitors significantly increased the proportion of patients with Hidradenitis Suppurativa Symptom Daily Diary (HSSDD) worst skin pain response (RR 2.46, 95% CI 1.41–4.30). The IL-17 inhibitor group was associated with a statistically significant decrease in HSSDD worst skin pain score from baseline compared with the placebo group (MD −1.02, 95% CI −1.44 to −0.60). The intervention group was also associated with a statistically significant decrease in Dermatology Life Quality Index score from baseline compared with the placebo group (MD −1.77, 95% CI −2.54 to −0.99). The treatment-emergent adverse events were similar in both groups. Conclusions IL-17 inhibitors are associated with an improvement in clinical response and pain outcomes in patients with moderate-to-severe HS, with an acceptable safety profile in the available studies. Given the limited number of trials with no head-to-head comparisons, further large-scale and independent studies are required to clarify their long-term role, particularly in patients whose HS is refractory to conventional and biologic therapies.