The Effectiveness of Medical Therapies for Joint, Skin and Eye Extraintestinal Manifestations in IBD—An Umbrella Review

Background

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.

Aims

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.

Methods

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).

Results

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.

Conclusions

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.