Comparative effectiveness of IL-12/23 and IL-23 inhibitors versus JAK inhibitors in patients with inflammatory bowel disease and hidradenitis suppurativa: a real-world propensity-matched analysis
Youssef Hafez, Ali Osman, Wing-Kin Syn, Manar ShmaisAbstract
Background
Inflammatory bowel disease (IBD) and hidradenitis suppurativa (HS) frequently coexist and share overlapping immune pathways, yet comparative real-world outcomes between IL-12/23 or IL-23 inhibitors and Janus kinase (JAK) inhibitors in this population remain poorly defined.
Methods
We conducted a retrospective cohort study using a large, multicenter, real-world dataset. Adults (≥16 years) with IBD and HS who initiated an IL-12/23 or IL-23 inhibitor after anti-TNF therapy or a JAK inhibitor were included; patients with prior exposure to the opposing drug class were excluded. Propensity score matching (1:1) yielded 150 patients per cohort. Outcomes from 30-365 days included acute care utilization, corticosteroid use, IBD complications, and overall and hidradenitis-specific antibiotic use.
Results
After propensity score matching, 300 patients were included (150 per cohort; mean age 38 years; 75.3% female). Rates of emergency department visits or hospitalization were similar between groups (RR 1.20, 95% CI, 0.82-1.77). Corticosteroid use risk was numerically higher in the IL-12/23 or IL-23 cohort (RR 1.20, 95% CI, 0.98-1.46). IBD-related complications did not differ significantly (RR 1.06, 95% CI, 0.58-1.93). Overall antibiotic use was comparable, while hidradenitis-specific antibiotic use was higher in the IL-12/23 or IL-23 cohort (RR 1.47, 95% CI, 1.11-1.95).
Conclusions
In this real-world analysis, IL-12/23 or IL-23 inhibitor therapy was associated with higher hidradenitis-specific antibiotic use and numerically greater but statistically nonsignificant corticosteroid exposure, while hospitalization and IBD-related complications were comparable. These findings should be interpreted cautiously given the absence of validated disease-activity measures; prospective studies are needed to inform optimal therapeutic selection.