Nardone Olga M, Noor Nurulamin M, Prabhu Aniruddh, Lim Alessandra, Krishnakumar Anirudh, Alajmi Abdulaziz, Yuan Yuhong, Jairath Vipul, Estevinho Maria Manuela, Solitano Virginia
Gastroenterology, Department of Public Health, University Federico II of Naples, Naples, Italy.
Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge, UK.
Aliment Pharmacol Ther. 2025 Jun;61(12):1854-1871. doi: 10.1111/apt.70181. Epub 2025 May 6.
Extraintestinal manifestations (EIMs) occur commonly in patients with inflammatory bowel disease (IBD), affecting joints, skin, eyes and other organs, and contributing to morbidity and long-term disability.
To synthesise evidence from systematic reviews (SRs) on the effectiveness and safety of medical treatments for IBD EIMs in IBD of joints, skin and eyes.
For this umbrella review, we searched three databases for relevant SRs published until May 30, 2024. Two independent reviewers performed screening, data extraction and quality appraisal (AMSTAR-2).
Ten, 12 and six SRs, respectively, provided data on medical therapies for articular, dermatological and ocular manifestations. Anti-TNF therapy showed high response rates for axial (59.1%-61.8%) and peripheral arthritis (73.4%-81.2%). The lowest improvement was in patients treated with vedolizumab for joint manifestations. Ustekinumab was effective for arthralgia and psoriatic arthritis, but not for axial spondylarthritis. High heterogeneity of response was reported for anti-TNF, vedolizumab, ustekinumab and tofacitinib (21%-100%) depending on the dermatological manifestation. No SRs evaluated IL-23 p40 antagonists or other oral small molecules. The incidence of new ocular EIMs was 1% for vedolizumab and ustekinumab. Anti-TNF agents were effective for most ocular EIM cases. Ustekinumab improved ocular symptoms in 55%-59%. Safety data were limited, with evidence certainty ranging from moderate to low.
Evidence for medical therapies for joint, skin and eye EIMs in IBD is heterogeneous and of low quality. Further research is needed, including a multidisciplinary approach and novel and practical methods for endpoint evaluation.
肠外表现（EIMs）在炎症性肠病（IBD）患者中很常见，会影响关节、皮肤、眼睛和其他器官，并导致发病和长期残疾。
综合系统评价（SRs）中关于IBD关节、皮肤和眼部肠外表现的药物治疗有效性和安全性的证据。
对于本伞状评价，我们在三个数据库中检索了截至2024年5月30日发表的相关SRs。两名独立的评价者进行筛选、数据提取和质量评估（AMSTAR-2）。
分别有10项、12项和6项SRs提供了关于关节、皮肤和眼部表现药物治疗的数据。抗TNF治疗对轴性关节炎（59.1%-61.8%）和外周关节炎（73.4%-81.2%）显示出高缓解率。维得利珠单抗治疗关节表现的患者改善程度最低。乌司奴单抗对关节痛和银屑病关节炎有效，但对轴性脊柱关节炎无效。根据皮肤表现，抗TNF、维得利珠单抗、乌司奴单抗和托法替布的缓解存在高度异质性（21%-100%）。没有SRs评估IL-23 p40拮抗剂或其他口服小分子药物。维得利珠单抗和乌司奴单抗新发性眼部肠外表现的发生率为1%。抗TNF药物对大多数眼部肠外表现病例有效。乌司奴单抗使55%-59%的眼部症状得到改善。安全性数据有限，证据确定性从中度到低度不等。
IBD关节、皮肤和眼部肠外表现的药物治疗证据存在异质性且质量较低。需要进一步研究，包括多学科方法以及新的实用终点评估方法。
