Delphi consensus: First‐line use of biologics and small molecules in hidradenitis suppurativa

作者：Georgios Nikolakis, Erkan Alpsoy, Florian Anzengruber, Matthias Augustin, Falk G. Bechara, Pierre‐André Bécherel, Farida Benhadou, Vincenzo Bettoli, Joana Cabete, Raffaele Dante Caposiena, Antonella Di Cesare, Giovanni Damiani, Valentina Dini, Evangelos J. Giamarellos‐Bourboulis, K. Gáspár, K. Glasenhardt, Philippe Guillem, A. Häfner, Barbara Horvath, John R. Ingram, Vaiva Jarienè, Gregor B. E. Jemec, Alexander Katoulis, Natalia Kirsten, G. Kokolakis, Piotr K. Krajewski, Aikaterini Ι. Liakou, Flavia Manzo Margiotta, Angelo V. Marzano, Antonio Martorell, Lukasz Matusiak, Dillon Mintoff, Alejandro Molina Leyva, Andreas Pinter, Anna S. Pirogova, Maurizio Podda, Francesca Prignano, Jorge Montoya Romani, Marco ROMANELLI, Elia Rosi, Samed Sahin, Ditte M L Saunte, Sylke Schneider‐Burrus, Mariano Suppa, Jacek Szepietowski, Andrea Szegedi, Simon Francis Thomsen, Thrasyvoulos Tzellos, Anastasia Trigoni, Hessel H. Van Der Zee, Kelsey Van Straalen, Skaidra Valiukevičienė, E Vilarrasa, Esther von Stebut, Christos C. Zouboulis · 发表于：Journal of the European Academy of Dermatology and Venereology · 年份：2026 · DOI：10.1111/jdv.70264 · 被引用次数：3 · 研究领域：Hidradenitis Suppurativa and Treatments、Acne and Rosacea Treatments and Effects、Anorectal Disease Treatments and Outcomes

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease associated with significant diagnostic delays and impact on quality of life. Current guidelines prioritize antibiotics as first-line therapy, but experts increasingly recognize the need for earlier targeted therapy intervention to prevent irreversible scarring and tunnel formation. To establish consensus on clinical scenarios during the 14th European Hidradenitis Suppurativa Foundation Conference in February 2025, 54 HS experts participated in a Delphi consensus, using a Likert scale (-5 to +5) to vote on 16 statements concerning first-line therapy criteria with biologics and/or small molecules for eligible patients. Seventy-eight HS experts were invited, and 54 participated via hybrid onsite and electronic voting. Experts rated 16 pre-defined statements regarding first-line use of biologics and/or small molecules for HS using a Likert scale (-5 to +5). Agreement metrics were stratified as majority agreement (≥70%, median 3.0-3.5), consensus (≥75%, median 3.5-4.5), and strong consensus (≥90%, median ≥4.5). Statements were subsequently ranked for clinical relevance. Strong consensus was reached for patients contraindicated for antibiotics, rapid disease progressors and those with severe disease. Consensus also supported upgrading patients with moderate disease (IHS4 ≥ 4), frequent flares (≥3 in 12 weeks), multiple affected areas and specific phenotypes including anogenital involvement. Strong consensus emerge...