Secukinumab Plus Upadacitinib for the Treatment of Severe Hidradenitis Suppurativa and Associated Immune-Mediated Comorbidities: A Case Series.

INTRODUCTION

Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease frequently associated with other immune-mediated inflammatory diseases (IMIDs), such as systemic lupus erythematosus (SLE) and psoriasis. Although advanced therapies have improved HS outcomes, many patients continue to experience suboptimal control, particularly when managing concurrent comorbidities. Combination therapy with biologics and small molecules may offer an effective strategy in select complex cases.

METHODS

We present three female patients with moderate-to-severe HS and systemic comorbidities (two with paradoxical palmoplantar psoriasis, one with SLE) who were treated with a combination of secukinumab and upadacitinib. All had previously failed at least two conventional systemic therapies. Secukinumab 300 mg was initiated first, followed by the addition of upadacitinib (15-30 mg) after 5-6 months.

RESULTS

The combination achieved significant improvement in HS activity and complete or near-complete resolution of comorbid conditions. Treatment was well tolerated, with no discontinuations or adverse events reported over 3-6 months of follow-up.

CONCLUSION

Our findings suggest that dual targeted therapy may represent a viable approach for patients with refractory disease and multiple immune-mediated conditions, warranting further investigation in larger cohorts.