Stephan R Vavricka1, Martin Gubler, Claudine Gantenbein, Muriel Spoerri, Florian Froehlich, Frank Seibold, Marijana Protic, Pierre Michetti, Alex Straumann, Nicolas Fournier, Pascal Juillerat, Luc Biedermann, Jonas Zeitz, Benjamin Misselwitz, Michael Scharl, Henriette Heinrich, Christine N Manser, Ekaterina Safroneeva, Raja Affendi Raja Ali, Gerhard Rogler, Alain M Schoepfer, Thomas Greuter. 1. 1Division of Gastroenterology and Hepatology, Triemli Hospital Zurich, Zurich, Switzerland; 2Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland; 3Division of Gastroenterology and Hepatology, University Hospital Basel, Basel, Switzerland; 4Division of Gastroenterology and Hepatology, University Hospital Lausanne-CHUV, Lausanne, Switzerland; 5Division of Gastroenterology, Lindenhof Spital, Bern, Switzerland; 6Division of Gastroenterology and Hepatology, Spital Tiefenau, Bern, Switzerland; 7Crohn and Colitis Center, Clinique La Source-Beaulieu, Lausanne, Switzerland; 8Praxis Römerhof, Olten, Switzerland; 9Institute of Social and Preventive Medicine (IUMSP), University of Lausanne, Lausanne, Switzerland; 10Department of Gastroenterology, Clinic for Visceral Surgery and Medicine, Inselspital, University Hospital of Bern, Bern, Switzerland; 11Department of Gastroenterology, See Spital, Horgen, Switzerland; 12Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland; and 13Division of Gastroenterology, The National University of Malaysia Medical Centre, Kuala Lumpur, Malaysia.
Abstract
BACKGROUND: Extraintestinal manifestations (EIMs) in patients with inflammatory bowel disease (IBD) are frequently observed. Little is known about the efficacy of anti-tumor necrosis factor (TNF) in EIM management. We assessed the effect of 3 anti-TNF agents (infliximab, adalimumab, and certolizumab pegol) on EIM evolution. METHODS: Data on 1249 patients from the Swiss IBD Cohort Study (SIBDCS) were analyzed. All EIMs were diagnosed by relevant specialists. Response was classified into improvement, stable disease, and clinical worsening based on the physician's interpretation. RESULTS: Of the 366 patients with at least 1 EIM, 213 (58.2%) were ever treated with an anti-TNF. A total of 299 treatments were started for 355 EIMs. Patients with EIM were significantly more often treated with anti-TNF compared with those without EIM (58.2% versus 21.0%, P < 0.001). Infliximab was the most frequently used drug (63.2%). In more than 71.8%, a clinical response of the underlying EIM to anti-TNF therapy was observed. In 92 patients (43.2%), anti-TNF treatments were started for the purpose of treating EIM rather than IBD. Response rates to anti-TNF were generally good and best for psoriasis, aphthous stomatitis, uveitis, and peripheral arthritis. In 11 patients, 14 EIM occurred under anti-TNF treatment. CONCLUSIONS: Anti-TNF was frequently used among patients with EIM. In more than 40%, anti-TNF treatments are started to treat EIM rather than IBD. Given the good response rates, anti-TNF seems to be a valuable option in the treatment of EIM, whereas appearance of EIM under anti-TNF does not seem to be a source of considerable concern.
BACKGROUND: Extraintestinal manifestations (EIMs) in patients with inflammatory bowel disease (IBD) are frequently observed. Little is known about the efficacy of anti-tumor necrosis factor (TNF) in EIM management. We assessed the effect of 3 anti-TNF agents (infliximab, adalimumab, and certolizumab pegol) on EIM evolution. METHODS: Data on 1249 patients from the Swiss IBD Cohort Study (SIBDCS) were analyzed. All EIMs were diagnosed by relevant specialists. Response was classified into improvement, stable disease, and clinical worsening based on the physician's interpretation. RESULTS: Of the 366 patients with at least 1 EIM, 213 (58.2%) were ever treated with an anti-TNF. A total of 299 treatments were started for 355 EIMs. Patients with EIM were significantly more often treated with anti-TNF compared with those without EIM (58.2% versus 21.0%, P < 0.001). Infliximab was the most frequently used drug (63.2%). In more than 71.8%, a clinical response of the underlying EIM to anti-TNF therapy was observed. In 92 patients (43.2%), anti-TNF treatments were started for the purpose of treating EIM rather than IBD. Response rates to anti-TNF were generally good and best for psoriasis, aphthous stomatitis, uveitis, and peripheral arthritis. In 11 patients, 14 EIM occurred under anti-TNF treatment. CONCLUSIONS: Anti-TNF was frequently used among patients with EIM. In more than 40%, anti-TNF treatments are started to treat EIM rather than IBD. Given the good response rates, anti-TNF seems to be a valuable option in the treatment of EIM, whereas appearance of EIM under anti-TNF does not seem to be a source of considerable concern.
Authors: David T Rubin; Walter Reinisch; Thomas Greuter; Paulo G Kotze; Marcia Pinheiro; Rajiv Mundayat; Eric Maller; Marc Fellmann; Nervin Lawendy; Irene Modesto; Stephan R Vavricka; Gary R Lichtenstein Journal: Therap Adv Gastroenterol Date: 2021-05-16 Impact factor: 4.409
Authors: Neeraj Narula; Achuthan Aruljothy; Emily C L Wong; Ravi Homenauth; Abdul-Aziz Alshahrani; John K Marshall; Walter Reinisch Journal: United European Gastroenterol J Date: 2021-06-02 Impact factor: 4.623