S1994 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

Introduction: Inflammatory bowel disease (IBD) patients with concomitant Hidradenitis Suppurativa (HS) represent a challenging population with limited data on optimal biologic selection. Anti-tumor necrosis factor (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 vs 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). Conclusion: 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.