Patients starting a biologic for hidradenitis suppurativa (HS) need to know up front that results take time, according to Jennifer Hsiao, M.D., dermatologist and researcher at the University of Southern California and member of the HS Foundation. Hsiao said she plans to reassess a patient's response at three to four months, and she sets that timeline at the very first visit.

HS is not like an infection that clears after a week of antibiotics, she said. The disease involves much inflammation that has to be brought under control. When patients know what to expect, they are more likely to stay on a drug even if it works more slowly than they hoped.

This patience matters because the list of options is short, she noted.

“We have a limited number of therapies. Patients also have an awareness about this,” Hsiao said. “They understand this concept of not wanting to just run through the treatments that are available, and you don't want to miss out on one where maybe they can ultimately achieve a good response, but you just didn't hang in there long enough.”

Her comments speak to a question health plans also weigh: how long a patient should stay on a specialty drug before switching is considered.

Looking ahead, Hsiao said she welcomes any new HS treatment that earns FDA approval with good efficacy and safety. HS varies from patient to patient in how the disease develops. Some patients respond well to drugs that target IL-17 but not to drugs that target TNF, or the reverse. Others don't respond well to either.

Janus kinase (JAK) inhibitors could help on two fronts, she said: They would give patients who dislike needles an oral option, and because they block a signaling pathway that affects many inflammatory proteins at once, they may help patients whose disease isn't driven mainly by one of them.

Hsiao added JAK inhibitors are the furthest along of the therapies in development. She pointed to povorcitinib, a JAK1-selective inhibitor that recently had efficacy and safety data published through 54 weeks.

Clinicians need more treatment options and Hsiao said she looks forward to being able to use these drugs once they are approved.