There are currently 2 Food and Drug Administration-approved treatments for hidradenitis suppurativa, and both are biologic medication -- Adalimumab, a monoclonal antibody targeting tumor necrosis factor-alpha and Secukinumab, an interleukin-17A inhibitor. While both medications have demonstrated modest benefit in patients with hidradenitis suppurativa, patients may lose response over time and neither treatment works in all patients. This review outlines the use of these 2 Food and Drug Administration-approved treatments, the best timing of biologic therapy initiation, the evolving pipeline of biologic treatments, and how to best utilize therapeutic drug monitoring to increase the longevity of these critical treatments.