Moderate-to-severe hidradenitis suppurativa (HS) is a debilitating disease that often requires biological therapy. Despite the effectiveness of approved doses, some patients experience partial or loss of response over time, leading to the need for dose intensification. This retrospective multicentre study aimed to identify predictors of biological therapy intensification in HS patients. The results showed that prior use of biological treatments and biosimilar adalimumab were significant predictors of intensification, suggesting closer monitoring may be needed for certain patient profiles to optimise treatment outcomes.