Clinical and Transcriptomic Response to Secukinumab in Korean Patients with Moderate-to-Severe Hidradenitis Suppurativa

Abstract

Introduction: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by recurrent painful nodules, abscesses, and tunnels, primarily affecting intertriginous areas. While IL-17-targeting biologics, including bimekizumab and secukinumab, have shown efficacy in moderate-to-severe HS, data in Asian populations remain limited. The aim of our study was to assess the clinical efficacy of secukinumab in Korean patients with moderate-to-severe HS and to perform an exploratory analysis of treatment-associated transcriptomic changes. Methods: Twenty-five patients with moderate-to-severe HS enrolled in a Managed Access Program (MAP) cohort received secukinumab 300 mg/week for 4 weeks, and then every 2 weeks through week 16. Clinical outcomes were assessed every 4 weeks. Paired lesional skin biopsies (baseline and week 12) from 3 patients underwent RNA sequencing to evaluate transcriptomic changes. Results: At week 16, 86.96% of patients achieved Hidradenitis Suppurativa Clinical Response (HiSCR), 78.26% reached a >= 55% reduction in the International Hidradenitis Suppurativa Severity Score System (IHS4 55), and 81.81% reported a >= 30% improvement in skin pain on the Numeric Rating Scale (NRS-30). Transcriptomic analysis revealed downregulation genes involved in epidermal development, keratinocyte differentiation, and antimicrobial response and upregulation of cell cycle-related pathways. Conclusions: Secukinumab demonstrated substantial clinical efficacy and modulated disease-relevant molecular pathways in Korean patients with moderate-to-severe HS. These findings support its therapeutic potential in Asian populations and provide mechanistic insights into IL-17 blockade in HS.