P0905 Incidence, risk factors, and management of acne in IBD patients on JAK Inhibitors: A multicentre retrospective cohort study (The JAKNE Project)
Authors: Gonzalez Lama MD- PhD Y , Calvo M , Alfageme F , Guerrero L , Wang S , Ortiz V , Algara M , González-Partida I , Rafael de la Cruz D , Matallana V , Masedo Á , Botella B , Yela C , López F , Gutiérrez P , Olmedo C , Cudero L , Casis B , Vera M I 
Published: January 2025

Background

Tofacitinib, filgotinib, and upadacitinib, are Janus kinase inhibitors (iJAKs) approved for inflammatory bowel disease (IBD) treatment. Although no comparative studies exist, potential differences in efficacy and safety are attributed to in vitro-demonstrated affinity of each molecule for different JAK isoforms. JAK1 plays a crucial role in modulating cytokine-mediated immune responses, such as IL-6 and interferon, which are involved in inflammation and skin homeostasis. Its inhibition can promote conditions that may trigger acne.

Acne may be increased in iJAK-treated patients, meaning a clinical challenge for gastroenterologists.

This study aims to identify the proportion of patients treated with iJAKs who develop acne, describe acne characteristics, risk factors, and management strategies.

Methods

A retrospective study was conducted at two referral centers in Madrid, Spain, including all IBD patients who had received iJAK therapy. Demographic data, disease-related variables, and acne characteristics (if appropriate) were collected.

Results

A total of 152 patients included; 64 (42%) were women. Eighty-two patients (54%) had ulcerative colitis, 70 (46%) had Crohn’s disease. Median age was 42.5 years (IQR 33.5-55). Sixty patients (39%) were treated with tofacitinib, 82 (54%) with upadacitinib, and 10 (7%) with filgotinib.

Twenty-four patients (16%) developed acne during iJAK treatment: 75% were mild, with only 1 severe case (4%). Acne occurred early (median onset 1.8 months, IQR 0-3), predominantly on the face (92%) and/or trunk (46%). Acne morphology included comedones (75%), papules (50%), pustules (37%), nodular-cystic (12%), scarring (12%); 42% showed more than one morphology.

Eleven patients received specific acne treatment: 54% topical (antiseptics, benzoyl peroxide, retinoids), 41% systemic (antibiotics, retinoids, antiandrogens), and 29% combined treatment. Only 3 patients (12% of those with acne; 2% overall) had to discontinue iJAK treatment, with acne resolving in all cases.

Variables associated with acne development included high iJAK doses (p=0.001), age &lt;35 years (p=0.005), and a history of acne (p=0.02). Acne developed in 21%, 8% and 2% of upadacitinib, tofacitinib and filgotinib treated patients respectively, though these differences were not statistically significant (p=0.09).

Conclusion

Acne occurred in a significant proportion of iJAK treated patients, was typically mild and manageable with specific dermatological intervention. Only a minority of cases required treatment discontinuation. Risk factors for iJAK-associated acne included dosage, younger age, and acne history. A trend toward a higher incidence of acne associated with upadacitinib may reflect its greater affinity for JAK1.