A Personalized Approach: Considerations for Appropriate Biologic Selection in Hidradenitis Suppurativa

EP: 1.Recognizing Hidradenitis Suppurativa: From First Signs to an Accurate Diagnosis

EP: 2.Hidden in Plain Sight: Strategies to Improve Early Identification of Hidradenitis Suppurativa

EP: 3.The Pharmacist Advantage: Bridging Gaps in Hidradenitis Suppurativa Care

EP: 4.Health Equity in Hidradenitis Suppurativa: Addressing Care Disparities

EP: 5.Proactive Hidradenitis Suppurativa Management: From Watchful Waiting to Active Intervention

EP: 6.Building Hidradenitis Suppurativa Treatment Plan: Evaluating Standard of Care Pharmacotherapies

EP: 7.The Role of Biologics for Treatment of Hidradenitis Suppurativa

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EP: 8.A Personalized Approach: Considerations for Appropriate Biologic Selection in Hidradenitis Suppurativa

When deciding which biologic to use in treatment, key considerations include both efficacy and safety profiles. Dermatologists typically rely on randomized controlled trial data, such as improvement in disease severity scales, to compare options. Currently, anti-TNF agents and IL-12/23 blockers are common biologics, each with distinct adverse effect profiles that influence their use. For example, patients with certain risks, like inflammatory bowel disease or infection susceptibility, may be better suited to one agent over another. While clinicians may choose the best treatment based on medical evidence and experience, insurance formularies and payer restrictions often impact the final prescribing decision, requiring collaboration and sometimes appeals to secure appropriate therapy.

Comorbidities play a critical role in biologic selection, as many patients have multiple overlapping conditions. Medications that treat more than one disease simultaneously—referred to as “double dippers”—are highly valued because they reduce the number of medications a patient takes, lowering risks of drug interactions and overall treatment costs. For instance, some anti-TNF agents are effective for both the skin disease and inflammatory bowel conditions, making them practical choices for patients with both. Other biologics may be preferable for those with metabolic or cardiovascular concerns. Considering the patient holistically helps optimize therapy and improves outcomes, while minimizing complications related to polypharmacy.

Beyond medical factors, practical challenges such as drug interactions, patient age, and insurance barriers influence biologic use. Mental health medications often interact with biologics, requiring careful review and multidisciplinary collaboration, including clinical pharmacists who can assist with insurance appeals and managing complex medication regimens. Age restrictions on some biologics also affect treatment plans, especially for younger patients. Resources like prior authorization letter templates from foundations help community providers navigate these hurdles. Overall, selecting a biologic involves balancing clinical evidence, patient-specific factors, and system-level considerations to provide the best possible care.