BI35 Skin-focused safety measures in upadacitinib-treated inflammatory bowel disease: a service evaluation

Abstract

Janus kinase inhibitors (JAKis), including upadacitinib, are increasingly used in moderate-to-severe inflammatory bowel disease (IBD) but carry class warnings for malignancy, nonmelanoma skin cancer (NMSC) and viral reactivation. People with IBD already have elevated baseline risks from disease-related and treatment-related immunosuppression. Guidance emphasizes infection screening and malignancy counselling when initiating a JAKi, but the consistency of skin-focused risk mitigation in routine gastroenterology practice is unclear. We evaluated upadacitinib use in a cohort with IBD, focusing on how skin cancer risk, infection risk and dermatology input are addressed and documented. We conducted a retrospective service evaluation of adults with IBD treated with upadacitinib between May 2023 and October 2025 at a UK centre. Demographic and clinical data were collected alongside documentation of skin cancer risk counselling, sun-safety advice, education on self-skin examination, smoking status, varicella zoster virus (VZV) testing, vaccination offers and dermatology referrals. Medical, nursing and pharmacy records, including standardized JAKi consent forms, were reviewed, using documentation as a pragmatic proxy for practice. Ninety-nine patients received upadacitinib (median age 33 years). Types of IBD were Crohn disease and ulcerative colitis. They had a median of two prior biologics that had failed, and 90% were previously exposed to at least one biologic. Documentation that skin cancer risk had been discussed was common (84%), largely reflecting generic consent forms, but practical risk mitigation was rarely recorded. Sun-safety advice and education on self-skin examination (1%) were documented only following combined dermatology review. VZV status was not checked in 14%, and vaccination was offered in 16%. Two patients developed incident NMSC (both basal cell carcinoma); no melanomas occurred. In this highly pretreated cohort of patients with IBD, JAKi risks were acknowledged, but structured skin-focused counselling and vaccination in line with current guidance were inconsistently documented. Reliance on generic consent templates obscures gaps in practical risk mitigation. A nurse-led JAKi safety checklist, embedded skin-risk discussion and concise patient information could support more consistent, sustainable skin-focused care.