Biologics vs. Immunosuppressants for Hidradenitis Suppurativa

It is often thought that biologics are used because it has been assumed Hidradenitis Suppurativa is an autoimmune illness, however, that is not the reason biologics are prescribed. There is a difference between biologics and immunosuppressant drugs.

Biologics are a type of immunosuppressant, however, the two types of medications work differently in the body, as explained below.


Immunosuppressants, also known as immunomodulators, decrease the body’s immune response in which there is an overactive immune system. Immunomodulators are specifically designed to decrease the body’s immune response which appears to be responsible for "causing” the inflammation and damage associated with inflammation. Immunomodulators are prescribed to treat typical autoimmune illnesses.


Biologics are used to treat inflammatory type illnesses. Depending on the person's illness(es) and severity, immunosuppressants and biologics may be used together.

Biologics are a class of medications that mimic normal molecules in living organisms or cells. They target specific proteins involved in the inflammatory process. For example, biologics block tumor necrosis factor-alpha, or TNF-alpha. TNF-alpha is an inflammatory cytokine that is present in elevated levels in inflammatory illnesses.

These biologics neutralize TNF-alpha’s ability to cause inflammation. In other words, biologics attempt to "prevent" the inflammation from occurring in the first place. In the case of Hidradenitis Suppurativa, researchers found that blocking a specific immune protein called ‘tumor necrosis factor’ (TNF) has slowed or stopped the body’s inflammatory reaction and decreased symptoms of HS.

How do biologics help with Hidradenitis Suppurativa?

Some biologics block cytokines or other pauses of inflammation that play a role in Hidradenitis Suppurativa. They can block the action of certain inflammatory cytokines or other molecules that help drive inflammation found in Hidradenitis Suppurativa.

With Hidradenitis Suppurativa known to be an inflammatory illness, biologics are the most effective as opposed to immunomodulators; not because it suppresses our immune system, but because it helps control and maintain the inflammation in our bodies.

Some immunosuppressant (immunomodulators) drugs:

  • Betamethasone

  • Budesonide

  • Cortisone

  • Dexamethasone

  • Hydrocortisone

  • Methylprednisolone

  • Prednisolone

  • Prednisone

  • Triamcinolone

  • Tofacitinib (Xeljanz)

  • Cyclosporine (Neoral, Sandimmune, SangCya)

  • Tacrolimus (Astagraf XL, Envarsus XR, Prograf)

  • Sirolimus (Rapamune)

  • Everolimus (Afinitor, Zortress)

  • Methotrexate

  • Azathioprine (Azasan, Imuran)

  • Leflunomide (Arava)

  • Mycophenolate (CellCept, Myfortic)

Some biologic drugs:

  • Abatacept (Orencia)

  • Adalimumab (Humira)

  • Anakinra (Kineret)

  • Certolizumab (Cimzia)

  • Etanercept (Enbrel)

  • Golimumab (Simponi)

  • Infliximab (Remicade)

  • Ixekizumab (Taltz)

  • Natalizumab (Tysabri)

  • Rituximab (Rituxan)

  • Secukinumab (Cosentyx)

  • Tocilizumab (Actemra)

  • Ustekinumab (Stelara)

  • Vedolizumab (Entyvio)

  • Basiliximab (Simulect)

  • Daclizumab (Zinbryta)

  • Risankizumab-rzaa (Skyrizi)

  • Tildrakizumab-asmn (llumya)

Content in this article is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking treatment because of something you have read on this website.

Written by Denise Panter-Fixsen

Edited by Brindley Kons



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