Janus Kinase (JAK) Inhibitor-Induced Acne in Inflammatory Bowel Disease: An International, Multicenter, Retrospective Cohort Study.

Background & Aims: JAK inhibitor-associated acne is a common but poorly understood adverse event. This study aimed to investigate the epidemiology, clinical characteristics, and treatment outcomes of this condition in patients with inflammatory bowel disease (IBD).

Methods: This international, multicenter, retrospective cohort study consecutively enrolled JAK-inhibitor-treated patients with IBD who subsequently developed acne. The primary objective was to evaluate the clinical characteristics of acne. Secondary objectives included determining acne prevalence, impact on quality of life, and antiacne treatment effectiveness.

Results: Among 2183 JAK inhibitor-treated patients with IBD, 272 developed acne. The crude prevalence rates of acne were 15.9% for upadacitinib, 4.3% for tofacitinib, and 1.9% for filgotinib, with dose-dependent relationships observed for upadacitinib and tofacitinib. Acne predominantly affected patients aged 30-50 years; most cases were mild-moderate in severity. A prior history of acne vulgaris was associated with significantly increased odds of developing severe JAK inhibitor-associated acne (odds ratio, 4.88; 95% confidence interval, 2.88-31.7; P = .0003) and acne-related skin complications (odds ratio, 3.92; 95% confidence interval, 1.56-10.11; P = .004). One-third of patients reported a negative psychosocial impact, and 40% received pharmacologic intervention. Eighteen percent of patients who developed acne required JAK inhibitor dose reduction or discontinuation, although most did not have severe disease.

Conclusions: This is the first study characterizing this adverse event in JAK inhibitor-treated patients with IBD and presents the largest cohort of JAK inhibitor-induced acne cases across all immune-mediated diseases. Acne is a common adverse effect resulting in significant psychological burden. Early identification, proactive counseling, and timely interventions, such as dose reduction or referral to dermatology, are crucial in managing this side effect.