Bimekizumab Shows Sustained Three-Year Efficacy in Hidradenitis Suppurativa as Treatment Landscape Expands
Key Insights
Bimekizumab demonstrated durable efficacy in hidradenitis suppurativa (search) with sustained responses extending up to three years in the BE HEARD extension trials.
The dual IL-17A/IL-17F (search) inhibitor achieved HiSCR response rates of 48-52% at week 16 compared to 29-32% with placebo in phase 3 trials.
Real-world evidence from 53 patients showed consistent efficacy with mean IHS4 reductions of 40-57% and complete remission in some cases.
The therapeutic landscape for hidradenitis suppurativa (search) (HS) reached a significant milestone in 2025, with bimekizumab demonstrating sustained three-year efficacy data while emerging as a leading treatment option in an increasingly diverse pipeline of therapies targeting this chronic inflammatory condition.
Phase 3 Trials Confirm Long-Term Benefits
The BE HEARD I and BE HEARD II phase 3 trials, involving 1,014 patients with moderate-to-severe HS, established bimekizumab's efficacy profile with statistically significant improvements in HiSCR endpoints. In BE HEARD I, 48% of patients receiving bimekizumab 320 mg every two weeks achieved HiSCR response compared to 29% with placebo (p = 0.0060). BE HEARD II showed similar results with 52% versus 32% response rates (p = 0.0032).
The durability of response became particularly evident in extended follow-up data. By week 48, HiSCR responses increased to approximately 61% and 64% in BE HEARD I and II, respectively. More notably, preliminary two-year data from the BE HEARD EXT extension study showed that over 85% of initial responders maintained their improvements, with 90% sustaining HiSCR50 and 86% maintaining DLQI benefits from week 48 to 96.
"The depth and durability of response observed with dual IL-17A/IL-17F (search) inhibition may influence biologic selection earlier in the disease course, particularly for patients with refractory or severe disease," noted clinicians interviewed by Dermatology Times.
Real-World Evidence Supports Trial Outcomes
Despite bimekizumab's recent approval for HS in November 2024, early real-world evidence from 53 patients across multiple studies has shown consistent efficacy. The largest real-world cohort, reported by Mansilla Polo et al, included 34 patients with complete follow-up data at week 16. Mean IHS4 scores decreased significantly from 27.1 ± 13.8 at baseline to 15.6 ± 9.9 at week 16 (p<0.001), representing approximately a 43% reduction.
Additional real-world studies demonstrated similar outcomes. Ureña-Paniego et al observed substantial IHS4 reductions of 11.625 points (p < 0.05) in eight patients, while Molinelli et al reported complete remission in three out of four patients by week 16. A case report by Martora et al documented a 57% IHS4 reduction within 12 weeks in a patient with refractory disease.
Mechanism of Action Drives Superior Efficacy
Bimekizumab's unique dual inhibition of both IL-17A and IL-17F (search) distinguishes it from other IL-17-targeted therapies. Both cytokines are abundantly expressed in HS lesions and signal through the same receptor complex, inducing pro-inflammatory mediators including TNF (search), IL-1β, IL-6, and matrix metalloproteinases. While IL-17A homodimers exhibit the greatest pro-inflammatory activity, IL-17F is particularly abundant in HS lesions and often co-localizes with IL-1-producing cells in chronic lesions.
A recent network meta-analysis identified bimekizumab as the most efficacious biologic for treating moderate-to-severe HS, with significantly superior HiSCR response rates compared to secukinumab and adalimumab. The analysis ranked bimekizumab 320 mg administered biweekly highest across all efficacy endpoints.
Expanding Treatment Algorithm
The 2025 treatment landscape for HS underwent significant expansion beyond IL-17 targeting. Povorcitinib (Incyte; INCB054707), an oral selective JAK1 (search) inhibitor, advanced through phase 3 STOP-HS trials, demonstrating significant improvements in HiSCR50 compared with placebo as early as week 12. The success of povorcitinib highlighted growing interest in oral systemic therapies for patients unwilling or unable to use injectable biologics.
Novel therapeutic approaches also emerged in phase 2 development. Brivekimig (Sanofi; SAR442970), a dual-target nanobody designed to modulate TNF (search) and OX40L (search) pathways, showed encouraging efficacy signals in biologic-naïve patients. InflaRx (search) reported positive phase 2a data for INF904, an oral C5a receptor (search) antagonist targeting complement pathway inhibition, which achieved a mean decrease of 8.1 abscess and nodule lesions by week 4.
Safety Profile and Clinical Considerations
Bimekizumab demonstrated a consistent safety profile across trials and real-world studies. Commonly reported adverse effects included gastrointestinal disturbances, headache, and infections, while serious adverse events appeared uncommon. Oral candidiasis was the most frequently reported candida infection, with the majority being mild to moderate and resolving with standard antifungal therapy without treatment discontinuation.
The recommended regimen for HS involves 320 mg administered subcutaneously every two weeks through week 16, followed by monthly dosing thereafter. Disease severity assessments showed significant improvements, with mild cases increasing from 0% to 53.1% while severe cases dropped from 87.4% to 20.4% over two years.
Clinical Practice Implications
The 2025 developments in HS treatment reflected several key trends that are reshaping clinical practice. These include earlier intervention with advanced therapies to prevent irreversible disease progression, optimization of biologic sequencing rather than delayed escalation, and greater integration of patient-reported outcomes into treatment decisions.
By the end of 2025, HS was no longer viewed as a "single-drug" disease state but rather as one with an emerging treatment algorithm similar to psoriasis (search). The expanding therapeutic options provide clinicians with multiple validated targets and treatment approaches, suggesting that future years will further refine treatment algorithms and improve long-term outcomes for patients living with this challenging condition.