Bimekizumab for Hidradenitis Suppurativa from Trials to Real Life: A Review of the Published Literature.

Hidradenitis suppurativa (HS) is a chronic, debilitating inflammatory disorder of the hair follicles affecting areas rich in apocrine glands. Moderate-to-severe forms often require biologic therapies, including bimekizumab, a humanized monoclonal antibody that selectively inhibits IL-17A and IL-17F. Secukinumab, a fully human monoclonal antibody targeting IL-17A, and adalimumab, an anti-TNFα monoclonal antibody and the first biologic approved for HS, also represent established therapeutic options, reducing inflammatory lesions and pain with variable long-term response among patients. Approved in Europe and the USA in 2024 for HS, bimekizumab has shown promising efficacy in the BE HEARD I and II clinical trials, with significantly higher HiSCR response rates compared to placebo and improvements sustained through 48 weeks; the BE HEARD EXT extension study confirmed durable benefits at two years, with reduced disease severity and improved quality of life. This review included six studies (two trials, three case series, and one case report), highlighting consistent results in real-world settings, though limited by the drug's recent introduction. Observational studies reported significant reductions in IHS4, pain, and DLQI scores, with complete remission in some cases. The most frequent adverse events were mucocutaneous candidiasis, generally mild and manageable. Dual inhibition of IL-17A and IL-17F represents an innovative therapeutic approach for HS, with potentially greater efficacy than selective inhibitors. However, further large-scale, long-term real-world data are needed to confirm the drug's safety and effectiveness and to define the optimal role of bimekizumab in HS management.