What is the evidence that anti‑TNF agents are more effective than JAK inhibitors in patients with IBD and concomitant PSC

What is known

- The optimal approach for concurrent PSC-IBD is unclear, and no drug to date has effectively reduced PSC-related morbidity or mortality. ¹ - For anti-TNF in PSC, an early randomised controlled trial showed no effect, though retrospective analyses suggest possible benefit. ² - JAK inhibitors are described as an emerging/evolving therapy in IBD whose precise role and efficacy, including for liver outcomes, are still being investigated. ^1,3

What is unknown / caveats

- An early RCT of anti-TNF in PSC showed no effect, whereas retrospective analyses suggest possible benefit ² - No head-to-head anti-TNF vs JAK-inhibitor trial in PSC-IBD in the retrieved evidence - PSC-specific anti-TNF data are largely retrospective and conflicting - Whether any IBD therapy class improves liver-related outcomes in PSC-IBD remains unestablished.

## References

1. Pinnuck B, Lynch KD. Navigating the pharmacotherapeutic management of comorbid inflammatory bowel disease and primary sclerosing cholangitis. Expert Opin Pharmacother. 2024. PMID: 39316754.

2. Lynch KD, Keshav S, Chapman RW. The Use of Biologics in Patients with Inflammatory Bowel Disease and Primary Sclerosing Cholangitis. Curr Hepatol Rep. 2019. PMID: 31008013.

3. Parra-Izquierdo V, Ardila O, Márquez JR, Riveros J, Gómez-Venegas ÁA, Medrano-Almanza CA, Ballesteros M, Barreto-Pérez J, Frias-Ordoñez JS. REAL-WORLD EXPERIENCE WITH JANUS KINASE INHIBITORS IN EXTRAINTESTINAL MANIFESTATIONS AND INFLAMMATORY BOWEL DISEASE IN COLOMBIA: A COMPARATIVE STUDY (JAKEIM-IBD STUDY). Arq Gastroenterol. 2026. PMID: 41538670.

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_Draft, generated by the IBDology RAG and not yet clinician-reviewed. Answers are grounded in the retrieved literature listed above; a high faithfulness score means the answer matches its sources, not that the sources are correct._