VIDEO: ‘Optimally personalize’ care to safely target extraintestinal manifestations of IBD
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In a Healio video exclusive, Gil Y. Melmed, MD, MS, highlights certain therapies that should be avoided or included in the management of patients with extraintestinal manifestations of inflammatory bowel disease.
“When it comes to extraintestinal manifestations, we know that patients with IBD are at increased risk for various kinds of EIMs and, in many cases, patients are at risk for multiple extraintestinal manifestations with the most common involving the joints perhaps, in some cases, up to 50%, the skin in up to 10% to 15%, eye involvement in up to 5% and others as well,” Melmed, director of clinical trials at the Inflammatory Bowel Disease Center at Cedars-Sinai in Los Angeles, told Healio.
“The prevalence of extraintestinal manifestations is a little bit tricky to study because some extraintestinal manifestations may actually precede the diagnosis of IBD by several months and, in other cases, the presence of extraintestinal manifestations may not occur until later in the diagnosis,” he added.
According to Melmed, it “behooves” providers to understand what these extraintestinal manifestations are and how many “can independently be treated” by existing therapies for IBD. He also highlighted instances where extraintestinal manifestations “may be best treated” with medications that should often be avoided in certain patients with IBD.
For example, although nonsteroidal agents and corticosteroids may be effective for the treatment of joint manifestations such as spondyloarthropathy, they should be avoided on a chronic basis in IBD. Melmed noted some therapies should be avoided altogether, such as anti-tumor necrosis factor therapy in patients with both IBD and multiple sclerosis.
“We actually had clinical trials looking at the use of anti-TNF therapy to treat demyelinating disease such as multiple sclerosis, suggesting that patients with MS treated with anti-TNF therapy might actually have higher rates of exacerbation and quicker rates of relapse,” Melmed said, which indicates “that anti TNF therapies should be avoided and perhaps are absolutely contraindicated in this patient population.”
Conversely, there are also opportunities to treat two conditions with one drug.
Patients with IBD who also present with sacral ileitis, uveitis or psoriatic arthritis could be great candidates for anti-TNF therapy or treatment with a Janus kinase inhibitor, he said. Data also are available that support the use of interleukin-12/23 inhibitors for both uveitis and psoriatic arthritis.
“In summary, we had a great discussion about different extraintestinal manifestations and recognizing how to optimally personalize our treatments in order to target as many of the extraintestinal manifestations, together with IBD, in as safe a manner as possible,” Melmed said.
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Melmed GY. Managing extraintestinal manifestations of IBD: SpA, skin, eyes, brain, Presented at: GUILD Conference; Feb. 18-21, 2024 (hybrid meeting).
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