Analysis: End-of-Dose Effect May Guide Biologic Optimization in Hidradenitis Suppurativa
Key Takeaways
A retrospective cohort study of 107 patients with hidradenitis suppurativa (HS) found that response-pattern–guided biologic optimization was associated with improvements in disease severity, flare frequency, and patient-reported outcomes.
More than half of evaluable patients achieved a clinically meaningful reduction in International Hidradenitis Suppurativa Severity Score System (IHS4) scores following dose intensification or antibiotic addition.
The end-of-dose effect (EODE), characterized by disease recurrence before the next biologic injection, may help identify patients for treatment optimization, although prospective validation is needed.
A response-pattern–guided approach to biologic optimization was associated with improvements in disease severity and flare outcomes among patients with hidradenitis suppurativa (HS) who experienced partial responses to treatment, according to a retrospective cohort study published in JAMA Dermatology.
Investigators evaluated 107 patients at a tertiary dermatology center in France between January 2022 and March 2025. Eligible patients experienced at least four annual flares despite receiving standard-dose anti–tumor necrosis factor-α or anti–interleukin 17 therapy for at least 3 months.
The researchers used the presence of an end-of-dose effect (EODE), defined as recurrent disease activity before the next scheduled injection, to guide treatment selection. Patients with EODE underwent biologic dose intensification (n = 52), while those without EODE received additional long-term antibiotics (n = 50).
Biologic Optimization Associated With Sustained Clinical Improvement
At 3 to 5 months, mean International Hidradenitis Suppurativa Severity Score System (IHS4) scores decreased from 7.0 to 3.9 (P < 0.001). An IHS4 response, defined as a reduction of at least 3 points, occurred in 53.8% of evaluable patients. Additionally, 50.5% achieved an IHS4 reduction of at least 55%, 51.0% experienced a flare-frequency response, and 65.0% reported global improvement. Clinical improvements were sustained at 6 to 12 months among 65 patients with follow-up data.
An exploratory comparison favored dose intensification for flare-duration response, but the association was not significant after adjustment for multiple comparisons (adjusted P = 0.24).
"In this cohort of patients with HS who partially responded to biologics, a response-pattern–guided optimization framework was associated with clinically meaningful improvement across all prespecified outcomes," the authors wrote. "The end-of-dose effect may serve as a candidate phenotyping tool to guide optimization strategy selection, pending prospective confirmation."
Source
Lynch A, Archimbaud J, Lesort C. JAMA Dermatology. 2026. Doi:10.1001/jamadermatol.2026.4435