Systematic review of tumour necrosis factor antagonists in extraintestinal manifestations in inflammatory bowel disease.

Systematic review of tumour necrosis factor antagonists in extraintestinal manifestations in inflammatory bowel disease.

Clin Gastroenterol Hepatol. 2016 Jul 5;

Authors: Peyrin-Biroulet L, Van Assche G, Gómez-Ulloa D, García-Álvarez L, Lara N, Black CM, Kachroo S

Abstract
BACKGROUND AND AIMS: This systematic review investigated the efficacy and the effectiveness of biologic drugs in extraintestinal manifestations (EIMs) in inflammatory bowel disease (IBD).
METHODS: Literature search was conducted in PubMed, Embase and Cochrane until October 2015. Main inclusion criteria were adults with IBD, use of a biologic drug, evolution of EIMs, interventional study (IS) or non-interventional study (NIS).
RESULTS: Nine IS [two randomized controlled trials (RCTs) (n=797), seven open label (OL) trials (n=1143)] and 13 NIS (n=914) were included. Tumour necrosis factor (TNF) antagonists achieved complete response for pyoderma gangrenosum in 21-25% of patients in IS and in 92-100% patients in NIS, with similar results for other cutaneous manifestations such as erythema nodosum or stomatitis. Adalimumab significantly reduced the prevalence of anaemia vs. placebo after 56 weeks in one RCT. In two NIS, anti-TNF therapy improved anaemia in the short-term (67%) and in the long-term (34%). Complete response after anti-TNF treatment was reported in IS, including arthralgia (reduction in prevalence from 47.1% to 26.8% in the mid-term in one OL trial) and arthritis (reduction in prevalence from 8.7% to 2.1% and from 58% to 12.5% in two OL trials). Anti-TNFs were beneficial for a majority of patients with ocular manifestations. Infliximab was associated with improved outcomes in bone formation and bone mineral density.
CONCLUSIONS: Anti-TNFs appear to be effective alternatives for certain EIMs associated with IBD including musculoskeletal, cutaneous and ocular manifestations while some beneficial effect may be obtained in metabolic bone disease, and on hematologic or vascular EIMs.

PMID: 27392760 [PubMed - as supplied by publisher]

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