Review Finds Rare IBD Events With IL-17 Inhibitors in Hidradenitis Suppurativa

Patients with hidradenitis suppurativa (HS) have an increased risk of inflammatory bowel disease (IBD), raising questions about whether IL-17 inhibitors increase that risk or unmask underlying disease. A JAMA Dermatology systematic review searched three databases through November 2025 and included 24 studies: 10 randomized trials, 11 nonrandomized studies, and three case reports. The outcome was new-onset or worsening Crohn disease or ulcerative colitis during treatment.

Across randomized trials, new-onset IBD occurred in 6 of 2,572 patients receiving IL-17 inhibitors (0.23%) and 0 of 1,066 receiving placebo through week 16. The pooled risk difference was 0.002 (95% CI, −0.003 to 0.007), indicating no statistically significant difference. Nonrandomized studies reported seven new-onset events among 469 patients, a crude incidence of 1.49%; the separately calculated pooled incidence was 3.90% (95% CI, 2.30%–6.50%). Across randomized trials, long-term extensions, and nonrandomized studies, investigators reported 17 new-onset cases and four IBD flares.

These findings provide short-term comparative safety data but do not establish the absence of increased IBD risk. Rare events, inconsistent reporting, and the 16-week placebo comparison limit interpretation. The evidence also leaves unresolved whether events represent treatment-associated disease or previously unrecognized IBD.