IL-17 inhibitors don't significantly raise IBD risk in hidradenitis suppurativa patients, meta-analysis finds

A new meta-analysis published in JAMA Dermatology offers some reassurance for clinicians treating hidradenitis suppurativa (HS) with IL-17 inhibitors. Across 24 studies — including 10 randomized clinical trials (RCTs) — new-onset inflammatory bowel disease (IBD) was rare, and no statistically significant difference in IBD risk was found between patients receiving IL-17 inhibitors (bimekizumab, secukinumab, sonelokimab, izokibep) and those on placebo.

That said, the picture isn't entirely clear. Nonrandomized, real-world studies showed notably higher IBD event rates compared to RCTs, and the authors caution that small event numbers and inconsistent baseline IBD reporting limit firm conclusions.

By the Numbers

• 0.23% — new-onset IBD rate in IL-17 inhibitor-treated patients in RCTs through week 16 vs. 0% in placebo
• 0.16% crude incidence of new-onset IBD between weeks 16–52 in RCTs (pooled: 0.3%)
• 1.49% crude incidence in nonrandomized studies (pooled: 3.9%)
• 21 total IBD events (17 new-onset, 4 flares) across all study types

Why it matters

For dermatologists and gastroenterologists co-managing HS patients, this data provides cautious reassurance — but also a call to action. Standardized IBD outcome reporting in future trials is essential to better quantify risk and guide safer prescribing decisions.