Real-World Experience with Janus Kinase Inhibitors in Severe Refractory Hidradenitis Suppurativa: A Retrospective Case Series.

Hidradenitis suppurativa (HS) is a chronic inflammatory disease with limited treatment options for patients with severe, treatment-refractory disease. The JAK-STAT pathway represents a potential therapeutic target, although real-world evidence for JAK inhibitors (JAKi) in HS remains limited. This retrospective case series describes eight male patients with Hurley stage III HS who received tofacitinib (n=3), upadacitinib (n=4), or ivarmacitinib (n=1) after inadequate response to conventional therapies. Clinical outcomes were assessed using the International Hidradenitis Suppurativa Severity Score System (IHS4) and a numerical rating scale (NRS) for pain at the latest available follow-up. Follow-up ranged from 1 week to 12 months. Seven patients showed improvement in inflammatory lesions and/or pain, whereas one patient receiving tofacitinib showed limited clinical benefit. The median reduction in IHS4 score was 9.5 points (range, 2-18), and the median reduction in NRS pain score was 4.0 points (range, 0-5). Temporary interruption of upadacitinib in one patient was followed by disease flare, with improvement again observed after treatment re-initiation. No severe infections, thromboembolic events, HBV reactivation, or treatment-limiting adverse events were identified during the available follow-up. These preliminary observations suggest that JAKi may have a potential role in selected patients with severe, treatment-refractory HS. However, responses and follow-up durations were heterogeneous, and the small sample size precludes comparisons between agents. Prospective controlled studies with standardized assessment timepoints and longer follow-up are needed to clarify efficacy, durability, and long-term safety.