Where Oral Therapies Fit in the HS Treatment Algorithm

The conversation in "Where Oral Therapies Fit in the HS Treatment Algorithm" turns to where oral therapies might fit alongside today's biologics.

Discussing where povorcitinib, upadacitinib, and remibrutinib might fit if approved, Dr. Bush believes any of them could serve as first-line or second-line therapy, since response cannot be predicted in advance; she would let patients choose between an oral option and an injectable one. Her stated wish is rapid approval and insurance coverage, along with earlier use to prevent patients from reaching advanced, disabling disease stages. Chao pushes back on the common claim that GLP-1 medications have made patients broadly comfortable with injections, arguing that patients remain just as resistant to injections as ever, which makes them genuinely receptive to oral alternatives. He plans to present oral and injectable options side by side as equal first-line choices in his own clinic. Dr. Bush compares this moment to the earlier era of psoriasis treatment, when several approved drugs, including methotrexate and adalimumab, were presented to patients together as parallel options, and she hopes for similarly early access with HS therapies going forward. Turning to how an expanding range of options might affect earlier treatment escalation, Dr. Bush argues that more available tools will keep patients from reaching a severely disabling stage of disease, noting that some HS patients are truly disabled by the condition today. Chao adds that his personal goal is to prevent any patient from progressing beyond early stage 2 disease, given the growing compendium of options now available, and sees no reason patients should still advance to later-stage or stage 3 disease. Both frame the expanding treatment landscape as an opportunity to start therapy earlier across the board, potentially changing the disease trajectory for the majority of patients who currently face years of delay before receiving truly effective care.

Our final episode, "Improving Early Identification and Escalation of HS," closes with practical advice for recognizing and escalating HS sooner.