Treatment with interleukin (IL)-17 inhibitors in patients with hidradenitis suppurativa does not appear to contribute to an increase in the risk of inflammatory bowel disease (IBD), according to a meta-analysis.
Pooled data from 10 randomized controlled trials (RCTs) showed no significant difference in the incidence of new-onset IBD, which occurred in only six patients treated with IL-17 inhibitors (four with bimekizumab and two with secukinumab) and none of those who received placebo through week 16 (0.23 percent vs 0 percent; risk difference, 0.002, 95 percent confidence interval [CI], −0.003 to 0.007). [JAMA Dermatol 2026;doi:10.1001/jamadermatol.2026.3373]
Across 11 nonrandomized studies, seven new-onset IBD events were documented. These included five with secukinumab, one with bimekizumab, and another one with izokibep. The corresponding pooled incidence rate was 3.9 percent (95 percent CI, 2.3–6.5).
Looking at the timing of IBD events, a total of 17 new-onset cases and four flares were reported across randomized trials, long-term extension studies, and nonrandomized studies. Of these 21 events, seven occurred by week 16, eight between weeks 16 and 52, and three after week 52. Timing was not reported for the remaining three events.
“Although hidradenitis suppurativa is associated with IBD, an additive risk with IL-17 inhibitor treatment was not observed. Our analysis is broadly consistent with prior safety analyses of IL-17 inhibition in psoriasis, psoriatic arthritis, and spondyloarthritis, which have also found low incidence of IBD events,” according to the investigators. [Rheumatol Ther 2021;8:1603-1616]
“The findings of our study support a low risk of IBD in patients with hidradenitis suppurativa treated with IL-17 inhibitors,” they said.
However, current guidelines recommend avoiding IL-17 inhibitors in patients with concomitant active IBD. For patients with HS without known IBD, clinicians are advised to conduct a thorough gastrointestinal history before initiating treatment with IL-17 inhibitors and to monitor patients for gastrointestinal symptoms. [Lancet 2025;405:420-438]
The investigators also acknowledged that although the absolute risk of IBD was low, the number of IBD events was small overall and the reporting of baseline IBD status and outcomes was inconsistent across the included studies.
Furthermore, differences across study designs should be considered, they said. “Nonrandomized studies demonstrated higher incidence rates than RCTs, likely reflecting broader inclusion criteria, less stringent exclusion of patients with prior IBD, and longer follow-up periods. Conversely, RCT populations may underestimate rare adverse events because of shorter study durations, selective enrolment, and exclusion of patients at higher risk for IBD,” they explained.
“Improved standardization in reporting of IBD across larger trials and studies in the community setting is needed to better estimate risk and strengthen the interpretation of safety data,” the investigators said.
The 10 RCTs included a total of 3,966 participants (mean age 36.8 years, 54.3 percent female), while the 11 nonrandomized studies involved 469 patients (mean age range 35–48.5 years) treated with an IL-17 inhibitor.