P5441 - Real-World Comparative Effectiveness of JAK Inhibitors and IL-12/23 or IL 23 Inhibitors in IBD Patients With Hidradenitis Suppurativa: Associations With Steroid Sparing and Healthcare Resource Use

Ali Osman, MD, MSCI Candidate¹, Manar Shmais, MD²
1Washington University School of Medicine in St. Louis, Ballwin, MO; 2SSM Health Saint Louis University Hospital, Saint Louis, MO

Introduction: Inflammatory bowel disease (IBD) patients with concomitant Hidradenitis Suppurativa (HS) represent a challenging population with limited data on optimal biologic selection. Anti-TNF agents have historically been the preferred treatment option for managing coexisting IBD and HS due to their efficacy in both conditions. However, in anti-TNF exposed patients , there is paucity of evidence regarding the preferred line of medication in this subpopulation. Both IL-12/23 (Ustekinumab), IL-23 (Risankizumab, Guselkumab, Mirikizumab), and JAK inhibitors (Tofacitinib, Upadacitinib) are used in this setting, yet real-world comparative outcomes remain unclear. We aim to compare the clinical effectiveness and healthcare utilization of JAK inhibitors versus IL-12/23 and IL-23 inhibitors in patients with IBD and HS.

Methods: We conducted a retrospective cohort study using the TriNetX Global Collaborative Network. Adult patients (≥18 years) with a diagnosis of IBD and Hidradenitis Suppurativa treated with JAK inhibitors or IL-12/23 and IL-23 inhibitors were identified. Propensity score matching (1:1) was performed to balance demographics and baseline comorbidities. Outcomes included HS abscess drainage, emergency department (ED) visits or hospitalizations, steroid use, IBD complications, and antimicrobial use. Risk ratios and chi-square tests were used for comparisons.

Results: A total of 630 matched patients (315 per group) were analyzed:

· HS Abscess Drainage: Lower in the JAK group (5.4% vs 9.3%), but not statistically significant (p = 0.129).

· ED Visits & Hospitalizations: Significantly lower in the JAK group (24.9% vs 28.8%; p = 0.009).

· Steroid Use: Significantly reduced in the JAK group (43.9% vs 54.6%; p = 0.030).

· IBD Complications: Similar between groups (JAK: 9.0% vs IL-12/23 or IL-23: 8.3%; p = 0.855).

· Antimicrobial Use: Slightly lower in the JAK group (51.7% vs 57.1%; p = 0.275).

Discussion: In this real-world study, JAK inhibitors were associated with significantly lower rates of steroid use and reduced healthcare utilization compared to IL-12/23 and IL-23 inhibitors in IBD patients with HS. These findings suggest potential advantages of JAK inhibitors in managing this complex patient population.


Figure: Table-1: Demographic Characteristics After Propensity Score Matching


Figure: Clinical Outcomes in IBD Patients with HS: JAK VS IL-12/23 or IL-23 Inhibitors

Disclosures:
Ali Osman indicated no relevant financial relationships.
Manar Shmais indicated no relevant financial relationships.

Ali Osman, MD, MSCI Candidate¹, Manar Shmais, MD². P5441 - Real-World Comparative Effectiveness of JAK Inhibitors and IL-12/23 or IL 23 Inhibitors in IBD Patients With Hidradenitis Suppurativa: Associations With Steroid Sparing and Healthcare Resource Use, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.