Efficacy of non-surgical monotherapies for hidradenitis suppurativa: a systematic review and network meta-analyses of randomized trials

We determined the relative efficacy of non-surgical monotherapies for hidradenitis suppurativa (HS).

Network meta-analyses were conducted to determine treatments’ surface under the cumulative ranking curve (SUCRA) value (i.e. an estimate that ranks efficacy); pairwise comparisons were conducted.

Ten trials were eligible for quantitative analyses; however, all did not have a common endpoint. Outcomes corresponded to pain severity, clinical response, quality of life and abscess count. For pain reduction, infliximab was ranked most efficacious (SUCRA = 94%) compared to bermekimab, anakinra and placebo; infliximab reduced pain more significantly (p < .05) than anakinra and then placebo. For the occurrence of clinical response, bimekizumab had the highest SUCRA (67%) relative to adalimumab, anakinra and placebo; bimekizumab was more efficacious than placebo (p < .05). For the quality of life in mild HS, Botox had the highest SUCRA (94%) compared to adalimumab and placebo; Botox was more efficacious than placebo (p < .05). For reduction in abscess count, oral tetracycline had the highest SUCRA (48%) compared to topical clindamycin and vehicle. Our work—being the first NMA study on non-surgical HS monotherapies—contributes to the comparative effectiveness literature for this condition.