Abstract

While adalimumab is effective in hidradenitis suppurativa, resistance and decreased response over time have spurred investigations into other biologics. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of adalimumab compared to other biologics (secukinumab, bimekizumab, MABp1, infliximab, anakinra, and spesolimab), using hidradenitis suppurativa clinical response (HiSCR) as the primary outcome. This review was conducted in accordance with the Preferred Reporting Items of Systematic Reviews and Meta-Analyses guidelines and registered in PROSPERO. The literature search was performed using PubMed and Google Scholar, using predefined keywords. The included studies were assessed using the Methodological Index for Non-Randomized Studies and Cochrane Rob2 tools for high risk of bias. From 549 records, 10 studies with 2,600 patients were included. Adalimumab improved symptoms and quality of life, especially with weekly use. Meta-analysis demonstrated that biologic therapies significantly improved HiSCR response compared to placebo (RR 1.73, 95% CI 1.21-2.49; p-value = 0.003), although substantial heterogeneity was observed (I² = 78%). Secukinumab showed higher response rates than placebo. Bimekizumab reduced lesions by up to 90% at week 12. Infliximab reduced lesions by half but caused transient polyarthritis. Side effects were mainly mild to moderate across treatments. Adalimumab was found to be currently the most extensively studied therapy, but emerging biologics such as secukinumab, bimekizumab, and infliximab demonstrated potential efficacy, particularly in biologic-naive patients. Current evidence supported the use of these agents in selected cases; however, further high-quality trials are needed to establish their comparative long-term safety and efficacy.

Key words: Systematic review, meta-analysis, hidradenitis suppurativa, acne inversa, skin disease, biologic therapies, adalimumab