Hidradenitis suppurativa
1st line Anti-TNF adalimumab.
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2nd line IL-17A inhibitor secukinumab OR IL-17A and IL-17F inhibitor bimekizumab.
IL-17A inhibitor secukinumab. In Hurley stage 2 moderate disease for whom adalimumab is contraindicated or otherwise unsuitable, including those who have failed to respond or have lost response to prior adalimumab treatment.
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IL-17A and IL-17F inhibitor bimekizumab. In Hurley stage 3 severe disease for whom adalimumab is contraindicated or otherwise unsuitable, including those who have failed to respond or have lost response to prior adalimumab treatment.
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3rd line IL-17A and IL-17F inhibitor bimekizumab. In Hurley stage 2 moderate disease for whom adalimumab and secukinumab are contraindicated or otherwise unsuitable, including those who have failed to respond or have lost response to prior adalimumab and secukinumab treatment.
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Prescribing Notes:
- Hidradenitis Suppurativa (HS) management is directed by a dermatology specialist prescriber experienced in the management of the condition, use is in line with relevant local or national guidance.
- For initial management with conventional systemic HS therapy refer to specialist guidelines for the management of HS. The patient information leaflet on HS from the British Association of Dermatologists provides an overview of available treatment options.
- Treatment is tailored to the individual, there are a number of management strategies to choose from. Among the possible treatment options are antibacterial skin lotions such as clindamycin topical lotion (off-label).
- Adalimumab is indicated for the treatment of active moderate to severe HS (acne inversa) in adult patients with an inadequate response to conventional systemic HS therapy.
- Secukinumab is indicated for the treatment of active moderate to severe HS (acne inversa) in adults with an adequate response to conventional systemic HS therapy and is restricted for use in adult patients with active moderate to severe HS for whom adalimumab is contraindicated or otherwise unsuitable, including those who have failed to respond or have lost response to prior adalimumab treatment.
- Bimekizumab is indicated for the treatment of active moderate to severe HS (acne inversa) in adults with an inadequate response to conventional systemic HS therapy and is restricted for use in adult patients with active moderate to severe HS for whom adalimumab is contraindicated or otherwise unsuitable, including those who have failed to respond or have lost response to prior adalimumab treatment.
History Notes
22/09/2025
Addition of bimekizumab SMC2698, ERFC July 2025.
06/02/2025
Addition of new amgevita formulations, ERWG Jan 24.
10/10/2024
Addition of Cosentyx (SMC2592), ERFC Aug 24.
15/12/2021
East Region Formulary content agreed.
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Prescribing Notes:
- The position of specialist treatment in this specialist dermatology pathway is not intended to guide on place in therapy. The place in therapy is directed by a dermatology specialist prescriber experienced in the management of the condition, use is in line with relevant local or national guidance.
- Refer to specialist guidelines for the management of hidradenitis suppuritiva.
- The patient information leaflet on hidradenitis suppuritiva from the British Association of Dermatologists provides an overview of available treatment options.
- Treatment is tailored to the individual, there are a number of management strategies to choose from. Among the possible treatment options are antibacterial skin lotions such as clindamycin topical lotion (off-label).
- Adalimumab is indicated for the treatment of active moderate to severe hidradenitis suppuritiva (HS) (acne inversa) in adults and adolescents from 12 years with an inadequate response to conventional systemic HS therapy.
History Notes
06/02/2025
Addition of new amgevita formulations, ERWG Jan 24.
31/05/2024
East Region Formulary content agreed.