Heim Pál National Pediatric Institute, Budapest, Hungary.
Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
J Crohns Colitis. 2024 Jun 3;18(6):851-863. doi: 10.1093/ecco-jcc/jjae002.
Extraintestinal manifestations are frequent in patients with inflammatory bowel disease and have a negative impact on quality of life. Currently, however, there is no evidence available to determine which drug should be recommended for these patients beyond anti-tumour necrosis factor [anti-TNF] treatment. We aimed to analyse the frequency of new extraintestinal manifestations and the behaviour of pre-existing extraintestinal manifestations during advanced therapy.
We conducted a systematic search on November 15, 2022, and enrolled randomized controlled trials, cohorts, and case series reporting the occurrence and behaviour of extraintestinal manifestations in patients with inflammatory bowel disease receiving advanced therapy [non-TNF inhibitor biologicals and JAK inhibitors]. Proportions of new, recurring, worsening, and improving extraintestinal manifestations were calculated with 95% confidence intervals [CIs]. The risk of bias was assessed with the QUIPS tool.
Altogether, 61 studies comprising 13,806 patients reported eligible data on extraintestinal manifestations. The overall proportion of new extraintestinal manifestations was 8% [95% CI, 6-12%] during advanced therapy. There was no significant difference between the frequency of new extraintestinal manifestations during vedolizumab and ustekinumab therapy [11%, 95% CI, 8-15% vs 6%, 95% CI, 3-11%, p = 0.166]. The improvement of pre-existing manifestations was comparable between vedolizumab- and ustekinumab-treated patients, except for joint involvement [42%, 95% CI, 32-53% vs 54%, 95% CI, 42-65%, p = 0.029].
The proportion of new extraintestinal manifestations was low during advanced therapy. Furthermore, the improvement of pre-existing manifestations was comparable between advanced therapies, except for pre-existing joint manifestations.
炎症性肠病患者常出现肠外表现，对生活质量有负面影响。然而，目前尚无证据可确定在抗肿瘤坏死因子[anti-TNF]治疗之外，应推荐哪些药物用于这些患者。本研究旨在分析在高级治疗期间新的肠外表现的发生频率和已存在的肠外表现的变化情况。
我们于 2022 年 11 月 15 日进行了系统检索，纳入了报告炎症性肠病患者接受高级治疗（非 TNF 抑制剂生物制剂和 JAK 抑制剂）时出现和变化情况的随机对照试验、队列研究和病例系列研究。采用 95%置信区间（CI）计算新的、复发的、恶化的和改善的肠外表现的比例。使用 QUIPS 工具评估偏倚风险。
共有 61 项研究（包含 13806 例患者）报告了关于肠外表现的合格数据。在高级治疗期间，新的肠外表现的总体比例为 8%（95%CI，6%-12%）。在 vedolizumab 和 ustekinumab 治疗期间，新的肠外表现的发生频率没有显著差异[11%（95%CI，8%-15%）vs. 6%（95%CI，3%-11%），p=0.166]。除关节受累外，vedolizumab 和 ustekinumab 治疗患者的已存在表现的改善情况相当[42%（95%CI，32%-53%）vs. 54%（95%CI，42%-65%），p=0.029]。
在高级治疗期间，新的肠外表现的比例较低。此外，除了已存在的关节表现外，高级治疗之间已存在表现的改善情况相当。
