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Anti-TNFs effective for extraintestinal manifestations in IBD
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Humira and Remicade appear to provide clinical benefit for some extraintestinal manifestations of inflammatory bowel disease, including musculoskeletal, cutaneous and ocular manifestations, and to a lesser degree in metabolic bone disease and hematologic or vascular manifestations, according to a systematic review.
Twelve to 35% of patients with ulcerative colitis and 25% to 70% of patients with Crohn’s disease “show comcomitant associated extraintestinal manifestations,” Laurent Peyrin-Biroulet, MD, PhD, from the gastroenterology department at Lorraine University in Vandoeuvre, France, and colleagues wrote. “The introduction of new biologic therapies for the management of IBD, particularly anti-TNF drugs, is perceived as an opportunity to improve the outcomes of EIMs in these patients; however, little is known about the efficacy and effectiveness of these new therapies in the management of EIMs.”
Laurent Peyrin-Biroulet
Peyrin-Biroulet and colleagues therefore conducted a systematic review of studies published up to October 2015 that investigated biologic drugs for EIMs in adults with IBD. They ultimately analyzed two randomized controlled trials (n = 797), seven open label trials (n = 1,143) and 13 non-interventional studies (n = 914), but did not perform a meta-analysis due to significant heterogeneity across studies.
Patients with pyoderma gangrenosum achieved complete response with anti-TNFs (21%-25% in interventional studies; 92%-100% in non-interventional studies), and patients with other cutaneous manifestations like erythema nodosum or stomatitis achieved comparable results with anti-TNFs.
One randomized controlled trial showed Humira (adalimumab, AbbVie) significantly reduced the prevalence of anemia compared with placebo after 56 weeks (P < .05), and two non-interventional studies showed anti-TNFs improved anemia in both the short- (67%) and long-term (34%).
Interventional studies also showed anti-TNFs induced complete response in patients with arthralgia and arthritis; prevalence of arthralgia dropped from 47.1% to 26.8% by the middle of an open-label trial, and prevalence of arthritis dropped from 8.7% to 2.1% in one open-label trial and from 58% to 12.5% in another.
Anti-TNFs were also shown to benefit most patients with ocular manifestations like uveitis, and Remicade (infliximab, Janssen) was linked to improved outcomes in bone formation and bone mineral density.
Although the evidence was limited, especially in ulcerative colitis, the investigators concluded that these data suggest that infliximab and adalimumab show clinical benefit for musculoskeletal, mucocutaneous and ocular manifestations of IBD, and potential benefit for metabolic bone disease and hematologic or vascular EIMs. Conversely, no or minimal data were found to suggest clinical benefit for Cimzia (certolizumab pegol, UCB), Simponi (golimumab, Janssen), Entyvio (vedolizumab, Takeda) or Tysabri (natalizumab, Biogen).
“The results of this systematic review support the recommendations provided in the recent ECCO consensus document on the use of anti-TNF drugs for the management of EIMs in IBD patients,” the researchers wrote. “However, the number of studies that have investigated the use of biologic therapy for the treatment of EIMs is relatively low and the sample sizes are often [too] small to draw any definitive conclusions,” they added. – by Adam Leitenberger
Disclosures: Peyrin-Biroulet reports lecture fees from Merck, AbbVie, Janssen, Takeda, Ferring, Norgine, Tillots, Vifor, Therakos, Mitsubishi and HAC-Pharma; and consulting fees from Merck, AbbVie, Janssen, Genentech, Mitsubishi, Ferring, Norgine, Tillots, Vifor, Therakos, Pharmacosmos, Pilège, BMS, UCB, Hospira, Celltrion, Takeda, Biogaran, Boehringer-Ingelheim, Lilly, Pfizer, HAC-Pharma, Index Pharmaceuticals, Amgen, Sandoz and Forward Pharma GmbH. Please see the full study for a list of all other researchers’ relevant financial disclosures.
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