HS is a chronic inflammatory disease characterized by skin lesions such as abscesses, inflammatory nodules (AN), and tunnels. As adalimumab is the only approved treatment, a high unmet need for new treatments exists. This research identified Randomised Controlled Trials (RCTs) in HS, assessed current evidence, and conducted an eNMA of current and future HS treatments. An SLR was conducted according to standard guidelines. Information on study/patient characteristics and efficacy outcomes were extracted. Outcomes assessed in the eNMA included clinical response, dermatological life quality index (DLQI), and pain score. Clinical response was evaluated using a range of Hidradenitis Suppurativa Clinical Response levels (HiSCR25,50,75,90), defined as at least a 25%, 50%, 75%, or 90% reduction from baseline in the total AN count, with no increase from baseline in abscess or draining tunnel count. A random-effect model was implemented, and treatments were ranked using p-scores. Twenty RCTs were identified. Outcomes from a total of (n=438) patients and six treatments (adalimumab, anakinra, apremilast, bermekimab, bimekizumab and placebo) were considered for the eNMA. Due to insufficient data, observed inconsistencies in outcome reporting, and heterogeneity in baseline demographics, comparisons were only feasible for endpoints measured at week 12 using data from five RCTs. HiSCR25 and HiSCR90 endpoints were excluded due to a lack of reporting. Bimekizumab ranked higher compared to adalimumab and placebo for HiSCR75, change from baseline in DLQI total score, and reduction in pain score. Inconsistencies in reporting endpoints, paucity of efficacy outcomes beyond 12-week, underreporting of HiSCR thresholds other than HiSCR50, and trial heterogeneity pose methodological challenges to future assessments informed by NMAs and cost-effectiveness analyses. This eNMA confirmed the early therapeutic benefits observed in NCT03248531 with bimekizumab in the change from baseline in DLQI score, pain score, and more stringent HiSCR threshold, but warrants confirmation in future RCTs.