\n<\/p>\n
April 17, 2026<\/p>\n
3 min read<\/p>\n<\/p><\/div>\n
\n \n \n Add topic to email alerts \n <\/span> \n <\/p>\n\n\n \n Receive an email when new articles are posted on \n <\/p>\n\n Please provide your email address to receive an email when new articles are posted on .<\/p><\/div>\n<\/p><\/div>\n “ \n data-action=”subscribe”> \n Subscribe \n <\/button>\n <\/div>\n<\/p><\/div>\n We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.<\/strong> <\/p>\nBack to Healio<\/button><\/p>\n<\/div>\n<\/div><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/div>\nKey takeaways:<\/h2>\n\nPatients with very severe hidradenitis suppurativa often reach an efficacy ceiling with monotherapy.<\/li>\nAdding a JAK1 inhibitor, anti-tumor necrosis factor inhibitor or anti-interleukin could improve outcomes.<\/li>\n<\/ul>\nDENVER \u2014 Dual biologic therapy should be considered for patients with very severe hidradenitis suppurativa, according to a speaker at the American Academy of Dermatology Annual Meeting. However, caution is advised for some combinations. <\/p>\nMedications and procedures that may improve HS signs and symptoms are \u201cnot quite enough\u201d for some patients, Jennifer<\/b> L.<\/b>\u00a0Hsiao, MD,<\/b> FAAD,<\/b> <\/b>associate professor of dermatology at Keck School of Medicine at the University of Southern California and a member of Healio Dermatology\u2019s Peer Perspective Board, said during a presentation. <\/p>\n \n \n \n \n <\/source><\/source><\/source><\/source><\/source><\/picture> \n Data derived from\u00a0Hsiao J. HS: Dual biologics and biologic + SMI. Presented at: American Academy of Dermatology Annual Meeting; March 27-31, 2026; Denver. \n <\/figcaption> \n <\/figure>\n\u201cEvery time you start a monotherapy biologic agent and give it an appropriate time to work, you keep running into an efficacy ceiling,\u201d Hsiao said. \u201cEvery time you get halfway up that mountain, the patient is feeling better, but they are still not functional. They can\u2019t go about their day-to-day [routine] and they are still on many pain medications. When this happens, instead of using prednisone and antibiotics … I\u2019d rather add a second targeted therapy.\u201d <\/p>\n<\/p>\nJennifer L. Hsiao<\/strong><\/p>\n<\/div>\nThere are currently three FDA-approved biologics for HS: adalimumab (Humira, AbbVie), a tumor necrosis factor (TNF) inhibitor; secukinumab (Cosentyx, Novartis), an interleukin-17A inhibitor; and bimekizumab (Bimzelx, UCB), an IL-17A\/F inhibitor. Due to the limited approved options, Hsiao said physicians also use JAK inhibitors and other IL inhibitors, such as IL-23 and IL-12\/23, off-label. <\/p>\nHsiao recommends the following dual biologic therapies for patients with very severe HS: <\/p>\n\nan anti-TNF as a base plus an anti-IL-17, anti-IL-23 (or 12\/23) or a JAK1 inhibitor;<\/li>\nan anti-IL17 as a base plus an anti-TNF, anti-IL-23 (or 12\/23) or a JAK1 inhibitor; or<\/li>\na JAK1 inhibitor as a base plus an anti-TNF, anti-IL-17 or anti-IL-23 or anti-IL-12\/23. <\/li>\n<\/ul>\nCombining these medications for HS is not a well-researched practice, but other specialties have been doing it for years, according to Hsiao. <\/p>\n\u201cOur gastroenterology and rheumatology colleagues have been using combination therapies to treat their patients with intestinal bowel disease,\u201d Hsiao said. \u201cSo, I think it is helpful to look at their literature to see how efficacy and safety have gone for them.\u201d <\/p>\nSafety considerations<\/h2>\nIn a phase 2a study published in January 2022 in the Journal of Crohn\u2019s and Colitis<\/i>, approximately 70 participants each were assigned to receive golimumab (Simponi, Johnson & Johnson), guselkumab (Tremfya, Johnson & Johnson) or a combination of the two. At week 12, the combination group achieved higher efficacy with the same adverse events rate compared with the monotherapy arms. Over 36% of participants in the combination group achieved clinical remission vs. 22.2% and 21.1% in the golimumab and guselkumab arms, respectively. Adverse events that led to discontinuation occurred in 2.8% of the combination group, 4.2% of the golimumab group and 1.4% of the guselkumab group. <\/p>\nSimilarly, a phase 2 trial published in Arthritis & Rheumatology<\/i> showed no increased risk for serious adverse events in patients with psoriatic arthritis who were assigned an anti-TNF and anti-IL-17A combination vs. those who received anti-TNF monotherapy.<\/p>\nAlthough dual biologic therapy may be promising for HS, Hsiao warns against a particular combination: TNF inhibitors plus anti-IL-1s. <\/p>\n\u201cIn a rheumatoid arthritis study that evaluated etanercept (Enbrel, Amgen), a TNF-inhibitor, vs. etanercept plus anakinra (Kineret, Sobi), an anti-IL-1, there was an increased risk for serious infection seen [with combination therapy],\u201d Hsiao said. \u201cIn my personal practice, I do not combine anti-TNFs and anti-IL-1s because, in part, it would be harder to explain the decision to a patient if they did end up getting a serious infection and this was in the literature.\u201d<\/p>\nNavigating insurance hurdles<\/h2>\nWhen dual biologic therapy is deemed necessary, insurance coverage for the second agent requires strategic planning, Hsiao said. One of the best approaches is to leverage a patient\u2019s comorbidities, according to Hsiao. <\/p>\n\u201cFor example, if I have a biologic for HS, I can get the JAK inhibitor covered for concomitant atopic dermatitis,\u201d Hsiao said. <\/p>\nHsiao noted that insurance coverage may also be easier if one infusion plus one subcutaneous injectable is prescribed vs. two subcutaneous injectables.<\/p>\nOther considerations before prescribing dual biologics, according to Hsiao, include planning ahead with the Shingrix zoster vaccine (GlaxoSmithKline) if introducing a JAK1 inhibitor, conducting lab monitoring depending on the biologic used, documenting a patient\u2019s disease baseline on monotherapy prior to combination treatment initiation and asking the patient what their administration preference is. <\/p>\n\u201cMy hope is that when we see a patient with HS who comes to our clinic, that regardless of their severity level, we feel a level of comfort in treating them,\u201d Hsiao said.<\/p>\n
\n Receive an email when new articles are posted on \n <\/p>\n\n Please provide your email address to receive an email when new articles are posted on .<\/p><\/div>\n<\/p><\/div>\n “ \n data-action=”subscribe”> \n Subscribe \n <\/button>\n <\/div>\n<\/p><\/div>\n We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.<\/strong> <\/p>\nBack to Healio<\/button><\/p>\n<\/div>\n<\/div><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/div>\nKey takeaways:<\/h2>\n\nPatients with very severe hidradenitis suppurativa often reach an efficacy ceiling with monotherapy.<\/li>\nAdding a JAK1 inhibitor, anti-tumor necrosis factor inhibitor or anti-interleukin could improve outcomes.<\/li>\n<\/ul>\nDENVER \u2014 Dual biologic therapy should be considered for patients with very severe hidradenitis suppurativa, according to a speaker at the American Academy of Dermatology Annual Meeting. However, caution is advised for some combinations. <\/p>\nMedications and procedures that may improve HS signs and symptoms are \u201cnot quite enough\u201d for some patients, Jennifer<\/b> L.<\/b>\u00a0Hsiao, MD,<\/b> FAAD,<\/b> <\/b>associate professor of dermatology at Keck School of Medicine at the University of Southern California and a member of Healio Dermatology\u2019s Peer Perspective Board, said during a presentation. <\/p>\n \n \n \n \n <\/source><\/source><\/source><\/source><\/source><\/picture> \n Data derived from\u00a0Hsiao J. HS: Dual biologics and biologic + SMI. Presented at: American Academy of Dermatology Annual Meeting; March 27-31, 2026; Denver. \n <\/figcaption> \n <\/figure>\n\u201cEvery time you start a monotherapy biologic agent and give it an appropriate time to work, you keep running into an efficacy ceiling,\u201d Hsiao said. \u201cEvery time you get halfway up that mountain, the patient is feeling better, but they are still not functional. They can\u2019t go about their day-to-day [routine] and they are still on many pain medications. When this happens, instead of using prednisone and antibiotics … I\u2019d rather add a second targeted therapy.\u201d <\/p>\n<\/p>\nJennifer L. Hsiao<\/strong><\/p>\n<\/div>\nThere are currently three FDA-approved biologics for HS: adalimumab (Humira, AbbVie), a tumor necrosis factor (TNF) inhibitor; secukinumab (Cosentyx, Novartis), an interleukin-17A inhibitor; and bimekizumab (Bimzelx, UCB), an IL-17A\/F inhibitor. Due to the limited approved options, Hsiao said physicians also use JAK inhibitors and other IL inhibitors, such as IL-23 and IL-12\/23, off-label. <\/p>\nHsiao recommends the following dual biologic therapies for patients with very severe HS: <\/p>\n\nan anti-TNF as a base plus an anti-IL-17, anti-IL-23 (or 12\/23) or a JAK1 inhibitor;<\/li>\nan anti-IL17 as a base plus an anti-TNF, anti-IL-23 (or 12\/23) or a JAK1 inhibitor; or<\/li>\na JAK1 inhibitor as a base plus an anti-TNF, anti-IL-17 or anti-IL-23 or anti-IL-12\/23. <\/li>\n<\/ul>\nCombining these medications for HS is not a well-researched practice, but other specialties have been doing it for years, according to Hsiao. <\/p>\n\u201cOur gastroenterology and rheumatology colleagues have been using combination therapies to treat their patients with intestinal bowel disease,\u201d Hsiao said. \u201cSo, I think it is helpful to look at their literature to see how efficacy and safety have gone for them.\u201d <\/p>\nSafety considerations<\/h2>\nIn a phase 2a study published in January 2022 in the Journal of Crohn\u2019s and Colitis<\/i>, approximately 70 participants each were assigned to receive golimumab (Simponi, Johnson & Johnson), guselkumab (Tremfya, Johnson & Johnson) or a combination of the two. At week 12, the combination group achieved higher efficacy with the same adverse events rate compared with the monotherapy arms. Over 36% of participants in the combination group achieved clinical remission vs. 22.2% and 21.1% in the golimumab and guselkumab arms, respectively. Adverse events that led to discontinuation occurred in 2.8% of the combination group, 4.2% of the golimumab group and 1.4% of the guselkumab group. <\/p>\nSimilarly, a phase 2 trial published in Arthritis & Rheumatology<\/i> showed no increased risk for serious adverse events in patients with psoriatic arthritis who were assigned an anti-TNF and anti-IL-17A combination vs. those who received anti-TNF monotherapy.<\/p>\nAlthough dual biologic therapy may be promising for HS, Hsiao warns against a particular combination: TNF inhibitors plus anti-IL-1s. <\/p>\n\u201cIn a rheumatoid arthritis study that evaluated etanercept (Enbrel, Amgen), a TNF-inhibitor, vs. etanercept plus anakinra (Kineret, Sobi), an anti-IL-1, there was an increased risk for serious infection seen [with combination therapy],\u201d Hsiao said. \u201cIn my personal practice, I do not combine anti-TNFs and anti-IL-1s because, in part, it would be harder to explain the decision to a patient if they did end up getting a serious infection and this was in the literature.\u201d<\/p>\nNavigating insurance hurdles<\/h2>\nWhen dual biologic therapy is deemed necessary, insurance coverage for the second agent requires strategic planning, Hsiao said. One of the best approaches is to leverage a patient\u2019s comorbidities, according to Hsiao. <\/p>\n\u201cFor example, if I have a biologic for HS, I can get the JAK inhibitor covered for concomitant atopic dermatitis,\u201d Hsiao said. <\/p>\nHsiao noted that insurance coverage may also be easier if one infusion plus one subcutaneous injectable is prescribed vs. two subcutaneous injectables.<\/p>\nOther considerations before prescribing dual biologics, according to Hsiao, include planning ahead with the Shingrix zoster vaccine (GlaxoSmithKline) if introducing a JAK1 inhibitor, conducting lab monitoring depending on the biologic used, documenting a patient\u2019s disease baseline on monotherapy prior to combination treatment initiation and asking the patient what their administration preference is. <\/p>\n\u201cMy hope is that when we see a patient with HS who comes to our clinic, that regardless of their severity level, we feel a level of comfort in treating them,\u201d Hsiao said.<\/p>\n
“ \n data-action=”subscribe”> \n Subscribe \n <\/button>\n <\/div>\n<\/p><\/div>\n We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.<\/strong> <\/p>\nBack to Healio<\/button><\/p>\n<\/div>\n<\/div><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/div>\nKey takeaways:<\/h2>\n\nPatients with very severe hidradenitis suppurativa often reach an efficacy ceiling with monotherapy.<\/li>\nAdding a JAK1 inhibitor, anti-tumor necrosis factor inhibitor or anti-interleukin could improve outcomes.<\/li>\n<\/ul>\nDENVER \u2014 Dual biologic therapy should be considered for patients with very severe hidradenitis suppurativa, according to a speaker at the American Academy of Dermatology Annual Meeting. However, caution is advised for some combinations. <\/p>\nMedications and procedures that may improve HS signs and symptoms are \u201cnot quite enough\u201d for some patients, Jennifer<\/b> L.<\/b>\u00a0Hsiao, MD,<\/b> FAAD,<\/b> <\/b>associate professor of dermatology at Keck School of Medicine at the University of Southern California and a member of Healio Dermatology\u2019s Peer Perspective Board, said during a presentation. <\/p>\n \n \n \n \n <\/source><\/source><\/source><\/source><\/source><\/picture> \n Data derived from\u00a0Hsiao J. HS: Dual biologics and biologic + SMI. Presented at: American Academy of Dermatology Annual Meeting; March 27-31, 2026; Denver. \n <\/figcaption> \n <\/figure>\n\u201cEvery time you start a monotherapy biologic agent and give it an appropriate time to work, you keep running into an efficacy ceiling,\u201d Hsiao said. \u201cEvery time you get halfway up that mountain, the patient is feeling better, but they are still not functional. They can\u2019t go about their day-to-day [routine] and they are still on many pain medications. When this happens, instead of using prednisone and antibiotics … I\u2019d rather add a second targeted therapy.\u201d <\/p>\n<\/p>\nJennifer L. Hsiao<\/strong><\/p>\n<\/div>\nThere are currently three FDA-approved biologics for HS: adalimumab (Humira, AbbVie), a tumor necrosis factor (TNF) inhibitor; secukinumab (Cosentyx, Novartis), an interleukin-17A inhibitor; and bimekizumab (Bimzelx, UCB), an IL-17A\/F inhibitor. Due to the limited approved options, Hsiao said physicians also use JAK inhibitors and other IL inhibitors, such as IL-23 and IL-12\/23, off-label. <\/p>\nHsiao recommends the following dual biologic therapies for patients with very severe HS: <\/p>\n\nan anti-TNF as a base plus an anti-IL-17, anti-IL-23 (or 12\/23) or a JAK1 inhibitor;<\/li>\nan anti-IL17 as a base plus an anti-TNF, anti-IL-23 (or 12\/23) or a JAK1 inhibitor; or<\/li>\na JAK1 inhibitor as a base plus an anti-TNF, anti-IL-17 or anti-IL-23 or anti-IL-12\/23. <\/li>\n<\/ul>\nCombining these medications for HS is not a well-researched practice, but other specialties have been doing it for years, according to Hsiao. <\/p>\n\u201cOur gastroenterology and rheumatology colleagues have been using combination therapies to treat their patients with intestinal bowel disease,\u201d Hsiao said. \u201cSo, I think it is helpful to look at their literature to see how efficacy and safety have gone for them.\u201d <\/p>\nSafety considerations<\/h2>\nIn a phase 2a study published in January 2022 in the Journal of Crohn\u2019s and Colitis<\/i>, approximately 70 participants each were assigned to receive golimumab (Simponi, Johnson & Johnson), guselkumab (Tremfya, Johnson & Johnson) or a combination of the two. At week 12, the combination group achieved higher efficacy with the same adverse events rate compared with the monotherapy arms. Over 36% of participants in the combination group achieved clinical remission vs. 22.2% and 21.1% in the golimumab and guselkumab arms, respectively. Adverse events that led to discontinuation occurred in 2.8% of the combination group, 4.2% of the golimumab group and 1.4% of the guselkumab group. <\/p>\nSimilarly, a phase 2 trial published in Arthritis & Rheumatology<\/i> showed no increased risk for serious adverse events in patients with psoriatic arthritis who were assigned an anti-TNF and anti-IL-17A combination vs. those who received anti-TNF monotherapy.<\/p>\nAlthough dual biologic therapy may be promising for HS, Hsiao warns against a particular combination: TNF inhibitors plus anti-IL-1s. <\/p>\n\u201cIn a rheumatoid arthritis study that evaluated etanercept (Enbrel, Amgen), a TNF-inhibitor, vs. etanercept plus anakinra (Kineret, Sobi), an anti-IL-1, there was an increased risk for serious infection seen [with combination therapy],\u201d Hsiao said. \u201cIn my personal practice, I do not combine anti-TNFs and anti-IL-1s because, in part, it would be harder to explain the decision to a patient if they did end up getting a serious infection and this was in the literature.\u201d<\/p>\nNavigating insurance hurdles<\/h2>\nWhen dual biologic therapy is deemed necessary, insurance coverage for the second agent requires strategic planning, Hsiao said. One of the best approaches is to leverage a patient\u2019s comorbidities, according to Hsiao. <\/p>\n\u201cFor example, if I have a biologic for HS, I can get the JAK inhibitor covered for concomitant atopic dermatitis,\u201d Hsiao said. <\/p>\nHsiao noted that insurance coverage may also be easier if one infusion plus one subcutaneous injectable is prescribed vs. two subcutaneous injectables.<\/p>\nOther considerations before prescribing dual biologics, according to Hsiao, include planning ahead with the Shingrix zoster vaccine (GlaxoSmithKline) if introducing a JAK1 inhibitor, conducting lab monitoring depending on the biologic used, documenting a patient\u2019s disease baseline on monotherapy prior to combination treatment initiation and asking the patient what their administration preference is. <\/p>\n\u201cMy hope is that when we see a patient with HS who comes to our clinic, that regardless of their severity level, we feel a level of comfort in treating them,\u201d Hsiao said.<\/p>\n
Back to Healio<\/button><\/p>\n<\/div>\n<\/div><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/div>\nKey takeaways:<\/h2>\n\nPatients with very severe hidradenitis suppurativa often reach an efficacy ceiling with monotherapy.<\/li>\nAdding a JAK1 inhibitor, anti-tumor necrosis factor inhibitor or anti-interleukin could improve outcomes.<\/li>\n<\/ul>\nDENVER \u2014 Dual biologic therapy should be considered for patients with very severe hidradenitis suppurativa, according to a speaker at the American Academy of Dermatology Annual Meeting. However, caution is advised for some combinations. <\/p>\nMedications and procedures that may improve HS signs and symptoms are \u201cnot quite enough\u201d for some patients, Jennifer<\/b> L.<\/b>\u00a0Hsiao, MD,<\/b> FAAD,<\/b> <\/b>associate professor of dermatology at Keck School of Medicine at the University of Southern California and a member of Healio Dermatology\u2019s Peer Perspective Board, said during a presentation. <\/p>\n \n \n \n \n <\/source><\/source><\/source><\/source><\/source><\/picture> \n Data derived from\u00a0Hsiao J. HS: Dual biologics and biologic + SMI. Presented at: American Academy of Dermatology Annual Meeting; March 27-31, 2026; Denver. \n <\/figcaption> \n <\/figure>\n\u201cEvery time you start a monotherapy biologic agent and give it an appropriate time to work, you keep running into an efficacy ceiling,\u201d Hsiao said. \u201cEvery time you get halfway up that mountain, the patient is feeling better, but they are still not functional. They can\u2019t go about their day-to-day [routine] and they are still on many pain medications. When this happens, instead of using prednisone and antibiotics … I\u2019d rather add a second targeted therapy.\u201d <\/p>\n<\/p>\nJennifer L. Hsiao<\/strong><\/p>\n<\/div>\nThere are currently three FDA-approved biologics for HS: adalimumab (Humira, AbbVie), a tumor necrosis factor (TNF) inhibitor; secukinumab (Cosentyx, Novartis), an interleukin-17A inhibitor; and bimekizumab (Bimzelx, UCB), an IL-17A\/F inhibitor. Due to the limited approved options, Hsiao said physicians also use JAK inhibitors and other IL inhibitors, such as IL-23 and IL-12\/23, off-label. <\/p>\nHsiao recommends the following dual biologic therapies for patients with very severe HS: <\/p>\n\nan anti-TNF as a base plus an anti-IL-17, anti-IL-23 (or 12\/23) or a JAK1 inhibitor;<\/li>\nan anti-IL17 as a base plus an anti-TNF, anti-IL-23 (or 12\/23) or a JAK1 inhibitor; or<\/li>\na JAK1 inhibitor as a base plus an anti-TNF, anti-IL-17 or anti-IL-23 or anti-IL-12\/23. <\/li>\n<\/ul>\nCombining these medications for HS is not a well-researched practice, but other specialties have been doing it for years, according to Hsiao. <\/p>\n\u201cOur gastroenterology and rheumatology colleagues have been using combination therapies to treat their patients with intestinal bowel disease,\u201d Hsiao said. \u201cSo, I think it is helpful to look at their literature to see how efficacy and safety have gone for them.\u201d <\/p>\nSafety considerations<\/h2>\nIn a phase 2a study published in January 2022 in the Journal of Crohn\u2019s and Colitis<\/i>, approximately 70 participants each were assigned to receive golimumab (Simponi, Johnson & Johnson), guselkumab (Tremfya, Johnson & Johnson) or a combination of the two. At week 12, the combination group achieved higher efficacy with the same adverse events rate compared with the monotherapy arms. Over 36% of participants in the combination group achieved clinical remission vs. 22.2% and 21.1% in the golimumab and guselkumab arms, respectively. Adverse events that led to discontinuation occurred in 2.8% of the combination group, 4.2% of the golimumab group and 1.4% of the guselkumab group. <\/p>\nSimilarly, a phase 2 trial published in Arthritis & Rheumatology<\/i> showed no increased risk for serious adverse events in patients with psoriatic arthritis who were assigned an anti-TNF and anti-IL-17A combination vs. those who received anti-TNF monotherapy.<\/p>\nAlthough dual biologic therapy may be promising for HS, Hsiao warns against a particular combination: TNF inhibitors plus anti-IL-1s. <\/p>\n\u201cIn a rheumatoid arthritis study that evaluated etanercept (Enbrel, Amgen), a TNF-inhibitor, vs. etanercept plus anakinra (Kineret, Sobi), an anti-IL-1, there was an increased risk for serious infection seen [with combination therapy],\u201d Hsiao said. \u201cIn my personal practice, I do not combine anti-TNFs and anti-IL-1s because, in part, it would be harder to explain the decision to a patient if they did end up getting a serious infection and this was in the literature.\u201d<\/p>\nNavigating insurance hurdles<\/h2>\nWhen dual biologic therapy is deemed necessary, insurance coverage for the second agent requires strategic planning, Hsiao said. One of the best approaches is to leverage a patient\u2019s comorbidities, according to Hsiao. <\/p>\n\u201cFor example, if I have a biologic for HS, I can get the JAK inhibitor covered for concomitant atopic dermatitis,\u201d Hsiao said. <\/p>\nHsiao noted that insurance coverage may also be easier if one infusion plus one subcutaneous injectable is prescribed vs. two subcutaneous injectables.<\/p>\nOther considerations before prescribing dual biologics, according to Hsiao, include planning ahead with the Shingrix zoster vaccine (GlaxoSmithKline) if introducing a JAK1 inhibitor, conducting lab monitoring depending on the biologic used, documenting a patient\u2019s disease baseline on monotherapy prior to combination treatment initiation and asking the patient what their administration preference is. <\/p>\n\u201cMy hope is that when we see a patient with HS who comes to our clinic, that regardless of their severity level, we feel a level of comfort in treating them,\u201d Hsiao said.<\/p>\n
DENVER \u2014 Dual biologic therapy should be considered for patients with very severe hidradenitis suppurativa, according to a speaker at the American Academy of Dermatology Annual Meeting. However, caution is advised for some combinations. <\/p>\n
Medications and procedures that may improve HS signs and symptoms are \u201cnot quite enough\u201d for some patients, Jennifer<\/b> L.<\/b>\u00a0Hsiao, MD,<\/b> FAAD,<\/b> <\/b>associate professor of dermatology at Keck School of Medicine at the University of Southern California and a member of Healio Dermatology\u2019s Peer Perspective Board, said during a presentation. <\/p>\n \n \n \n \n <\/source><\/source><\/source><\/source><\/source><\/picture> \n Data derived from\u00a0Hsiao J. HS: Dual biologics and biologic + SMI. Presented at: American Academy of Dermatology Annual Meeting; March 27-31, 2026; Denver. \n <\/figcaption> \n <\/figure>\n\u201cEvery time you start a monotherapy biologic agent and give it an appropriate time to work, you keep running into an efficacy ceiling,\u201d Hsiao said. \u201cEvery time you get halfway up that mountain, the patient is feeling better, but they are still not functional. They can\u2019t go about their day-to-day [routine] and they are still on many pain medications. When this happens, instead of using prednisone and antibiotics … I\u2019d rather add a second targeted therapy.\u201d <\/p>\n<\/p>\nJennifer L. Hsiao<\/strong><\/p>\n<\/div>\nThere are currently three FDA-approved biologics for HS: adalimumab (Humira, AbbVie), a tumor necrosis factor (TNF) inhibitor; secukinumab (Cosentyx, Novartis), an interleukin-17A inhibitor; and bimekizumab (Bimzelx, UCB), an IL-17A\/F inhibitor. Due to the limited approved options, Hsiao said physicians also use JAK inhibitors and other IL inhibitors, such as IL-23 and IL-12\/23, off-label. <\/p>\nHsiao recommends the following dual biologic therapies for patients with very severe HS: <\/p>\n\nan anti-TNF as a base plus an anti-IL-17, anti-IL-23 (or 12\/23) or a JAK1 inhibitor;<\/li>\nan anti-IL17 as a base plus an anti-TNF, anti-IL-23 (or 12\/23) or a JAK1 inhibitor; or<\/li>\na JAK1 inhibitor as a base plus an anti-TNF, anti-IL-17 or anti-IL-23 or anti-IL-12\/23. <\/li>\n<\/ul>\nCombining these medications for HS is not a well-researched practice, but other specialties have been doing it for years, according to Hsiao. <\/p>\n\u201cOur gastroenterology and rheumatology colleagues have been using combination therapies to treat their patients with intestinal bowel disease,\u201d Hsiao said. \u201cSo, I think it is helpful to look at their literature to see how efficacy and safety have gone for them.\u201d <\/p>\nSafety considerations<\/h2>\nIn a phase 2a study published in January 2022 in the Journal of Crohn\u2019s and Colitis<\/i>, approximately 70 participants each were assigned to receive golimumab (Simponi, Johnson & Johnson), guselkumab (Tremfya, Johnson & Johnson) or a combination of the two. At week 12, the combination group achieved higher efficacy with the same adverse events rate compared with the monotherapy arms. Over 36% of participants in the combination group achieved clinical remission vs. 22.2% and 21.1% in the golimumab and guselkumab arms, respectively. Adverse events that led to discontinuation occurred in 2.8% of the combination group, 4.2% of the golimumab group and 1.4% of the guselkumab group. <\/p>\nSimilarly, a phase 2 trial published in Arthritis & Rheumatology<\/i> showed no increased risk for serious adverse events in patients with psoriatic arthritis who were assigned an anti-TNF and anti-IL-17A combination vs. those who received anti-TNF monotherapy.<\/p>\nAlthough dual biologic therapy may be promising for HS, Hsiao warns against a particular combination: TNF inhibitors plus anti-IL-1s. <\/p>\n\u201cIn a rheumatoid arthritis study that evaluated etanercept (Enbrel, Amgen), a TNF-inhibitor, vs. etanercept plus anakinra (Kineret, Sobi), an anti-IL-1, there was an increased risk for serious infection seen [with combination therapy],\u201d Hsiao said. \u201cIn my personal practice, I do not combine anti-TNFs and anti-IL-1s because, in part, it would be harder to explain the decision to a patient if they did end up getting a serious infection and this was in the literature.\u201d<\/p>\nNavigating insurance hurdles<\/h2>\nWhen dual biologic therapy is deemed necessary, insurance coverage for the second agent requires strategic planning, Hsiao said. One of the best approaches is to leverage a patient\u2019s comorbidities, according to Hsiao. <\/p>\n\u201cFor example, if I have a biologic for HS, I can get the JAK inhibitor covered for concomitant atopic dermatitis,\u201d Hsiao said. <\/p>\nHsiao noted that insurance coverage may also be easier if one infusion plus one subcutaneous injectable is prescribed vs. two subcutaneous injectables.<\/p>\nOther considerations before prescribing dual biologics, according to Hsiao, include planning ahead with the Shingrix zoster vaccine (GlaxoSmithKline) if introducing a JAK1 inhibitor, conducting lab monitoring depending on the biologic used, documenting a patient\u2019s disease baseline on monotherapy prior to combination treatment initiation and asking the patient what their administration preference is. <\/p>\n\u201cMy hope is that when we see a patient with HS who comes to our clinic, that regardless of their severity level, we feel a level of comfort in treating them,\u201d Hsiao said.<\/p>\n
\u201cEvery time you start a monotherapy biologic agent and give it an appropriate time to work, you keep running into an efficacy ceiling,\u201d Hsiao said. \u201cEvery time you get halfway up that mountain, the patient is feeling better, but they are still not functional. They can\u2019t go about their day-to-day [routine] and they are still on many pain medications. When this happens, instead of using prednisone and antibiotics … I\u2019d rather add a second targeted therapy.\u201d <\/p>\n
Jennifer L. Hsiao<\/strong><\/p>\n<\/div>\nThere are currently three FDA-approved biologics for HS: adalimumab (Humira, AbbVie), a tumor necrosis factor (TNF) inhibitor; secukinumab (Cosentyx, Novartis), an interleukin-17A inhibitor; and bimekizumab (Bimzelx, UCB), an IL-17A\/F inhibitor. Due to the limited approved options, Hsiao said physicians also use JAK inhibitors and other IL inhibitors, such as IL-23 and IL-12\/23, off-label. <\/p>\nHsiao recommends the following dual biologic therapies for patients with very severe HS: <\/p>\n\nan anti-TNF as a base plus an anti-IL-17, anti-IL-23 (or 12\/23) or a JAK1 inhibitor;<\/li>\nan anti-IL17 as a base plus an anti-TNF, anti-IL-23 (or 12\/23) or a JAK1 inhibitor; or<\/li>\na JAK1 inhibitor as a base plus an anti-TNF, anti-IL-17 or anti-IL-23 or anti-IL-12\/23. <\/li>\n<\/ul>\nCombining these medications for HS is not a well-researched practice, but other specialties have been doing it for years, according to Hsiao. <\/p>\n\u201cOur gastroenterology and rheumatology colleagues have been using combination therapies to treat their patients with intestinal bowel disease,\u201d Hsiao said. \u201cSo, I think it is helpful to look at their literature to see how efficacy and safety have gone for them.\u201d <\/p>\nSafety considerations<\/h2>\nIn a phase 2a study published in January 2022 in the Journal of Crohn\u2019s and Colitis<\/i>, approximately 70 participants each were assigned to receive golimumab (Simponi, Johnson & Johnson), guselkumab (Tremfya, Johnson & Johnson) or a combination of the two. At week 12, the combination group achieved higher efficacy with the same adverse events rate compared with the monotherapy arms. Over 36% of participants in the combination group achieved clinical remission vs. 22.2% and 21.1% in the golimumab and guselkumab arms, respectively. Adverse events that led to discontinuation occurred in 2.8% of the combination group, 4.2% of the golimumab group and 1.4% of the guselkumab group. <\/p>\nSimilarly, a phase 2 trial published in Arthritis & Rheumatology<\/i> showed no increased risk for serious adverse events in patients with psoriatic arthritis who were assigned an anti-TNF and anti-IL-17A combination vs. those who received anti-TNF monotherapy.<\/p>\nAlthough dual biologic therapy may be promising for HS, Hsiao warns against a particular combination: TNF inhibitors plus anti-IL-1s. <\/p>\n\u201cIn a rheumatoid arthritis study that evaluated etanercept (Enbrel, Amgen), a TNF-inhibitor, vs. etanercept plus anakinra (Kineret, Sobi), an anti-IL-1, there was an increased risk for serious infection seen [with combination therapy],\u201d Hsiao said. \u201cIn my personal practice, I do not combine anti-TNFs and anti-IL-1s because, in part, it would be harder to explain the decision to a patient if they did end up getting a serious infection and this was in the literature.\u201d<\/p>\nNavigating insurance hurdles<\/h2>\nWhen dual biologic therapy is deemed necessary, insurance coverage for the second agent requires strategic planning, Hsiao said. One of the best approaches is to leverage a patient\u2019s comorbidities, according to Hsiao. <\/p>\n\u201cFor example, if I have a biologic for HS, I can get the JAK inhibitor covered for concomitant atopic dermatitis,\u201d Hsiao said. <\/p>\nHsiao noted that insurance coverage may also be easier if one infusion plus one subcutaneous injectable is prescribed vs. two subcutaneous injectables.<\/p>\nOther considerations before prescribing dual biologics, according to Hsiao, include planning ahead with the Shingrix zoster vaccine (GlaxoSmithKline) if introducing a JAK1 inhibitor, conducting lab monitoring depending on the biologic used, documenting a patient\u2019s disease baseline on monotherapy prior to combination treatment initiation and asking the patient what their administration preference is. <\/p>\n\u201cMy hope is that when we see a patient with HS who comes to our clinic, that regardless of their severity level, we feel a level of comfort in treating them,\u201d Hsiao said.<\/p>\n
There are currently three FDA-approved biologics for HS: adalimumab (Humira, AbbVie), a tumor necrosis factor (TNF) inhibitor; secukinumab (Cosentyx, Novartis), an interleukin-17A inhibitor; and bimekizumab (Bimzelx, UCB), an IL-17A\/F inhibitor. Due to the limited approved options, Hsiao said physicians also use JAK inhibitors and other IL inhibitors, such as IL-23 and IL-12\/23, off-label. <\/p>\n
Hsiao recommends the following dual biologic therapies for patients with very severe HS: <\/p>\n
Combining these medications for HS is not a well-researched practice, but other specialties have been doing it for years, according to Hsiao. <\/p>\n
\u201cOur gastroenterology and rheumatology colleagues have been using combination therapies to treat their patients with intestinal bowel disease,\u201d Hsiao said. \u201cSo, I think it is helpful to look at their literature to see how efficacy and safety have gone for them.\u201d <\/p>\n
In a phase 2a study published in January 2022 in the Journal of Crohn\u2019s and Colitis<\/i>, approximately 70 participants each were assigned to receive golimumab (Simponi, Johnson & Johnson), guselkumab (Tremfya, Johnson & Johnson) or a combination of the two. At week 12, the combination group achieved higher efficacy with the same adverse events rate compared with the monotherapy arms. Over 36% of participants in the combination group achieved clinical remission vs. 22.2% and 21.1% in the golimumab and guselkumab arms, respectively. Adverse events that led to discontinuation occurred in 2.8% of the combination group, 4.2% of the golimumab group and 1.4% of the guselkumab group. <\/p>\n
Similarly, a phase 2 trial published in Arthritis & Rheumatology<\/i> showed no increased risk for serious adverse events in patients with psoriatic arthritis who were assigned an anti-TNF and anti-IL-17A combination vs. those who received anti-TNF monotherapy.<\/p>\n
Although dual biologic therapy may be promising for HS, Hsiao warns against a particular combination: TNF inhibitors plus anti-IL-1s. <\/p>\n
\u201cIn a rheumatoid arthritis study that evaluated etanercept (Enbrel, Amgen), a TNF-inhibitor, vs. etanercept plus anakinra (Kineret, Sobi), an anti-IL-1, there was an increased risk for serious infection seen [with combination therapy],\u201d Hsiao said. \u201cIn my personal practice, I do not combine anti-TNFs and anti-IL-1s because, in part, it would be harder to explain the decision to a patient if they did end up getting a serious infection and this was in the literature.\u201d<\/p>\n
When dual biologic therapy is deemed necessary, insurance coverage for the second agent requires strategic planning, Hsiao said. One of the best approaches is to leverage a patient\u2019s comorbidities, according to Hsiao. <\/p>\n
\u201cFor example, if I have a biologic for HS, I can get the JAK inhibitor covered for concomitant atopic dermatitis,\u201d Hsiao said. <\/p>\n
Hsiao noted that insurance coverage may also be easier if one infusion plus one subcutaneous injectable is prescribed vs. two subcutaneous injectables.<\/p>\n
Other considerations before prescribing dual biologics, according to Hsiao, include planning ahead with the Shingrix zoster vaccine (GlaxoSmithKline) if introducing a JAK1 inhibitor, conducting lab monitoring depending on the biologic used, documenting a patient\u2019s disease baseline on monotherapy prior to combination treatment initiation and asking the patient what their administration preference is. <\/p>\n
\u201cMy hope is that when we see a patient with HS who comes to our clinic, that regardless of their severity level, we feel a level of comfort in treating them,\u201d Hsiao said.<\/p>\n