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  • Brindley Brooks

Biologics vs. Immunosuppressants for Hidradenitis Suppurativa

Reviewed by Troy Fugate, Vice President of Compliance Insight, Inc.

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

Simply stated, many immunosuppressant drugs are chemically derived compounds while biologics are made from biological materials such as blood cells. Biologics can be used as 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 can be used to treat inflammatory type illnesses. Depending on the person's illness(es) and severity, immunosuppressants and biologics may be used together.

Biologics, because of how they are made, are a class of medications that mimic normal molecules in living organisms or cells. They target specific proteins, on a cellular level, involved in the inflammatory process. For example, biologics can 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 causes 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 can be the most effective treatment as opposed to immunomodulators. Not because it suppresses our immune system, but because it helps control and maintain the causes of 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)

Watch our interview with Troy Fugate regarding biologics here.

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

Reviewed by Troy Fugate, Vice President of Compliance Insight, Inc.


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