Biologics for extraintestinal manifestations of IBD

Extraintestinal manifestations (EIM) in inflammatory bowel disease (IBD) occur frequently and may present themselves before or after IBD diagnosis. They most commonly affect the eyes, skin, and joints, but can also involve other organs such as the liver. Some EIM are associated with intestinal disease activity and ameliorate by treatment of the underlying IBD. This is seen in patients with peripheral Type 1 arthritis, oral aphthous ulcers, episcleritis, and erythema nodosum. Other EIM are intestinal disease activity-independent such as uveitis, and ankylosing spondylitis. Finally, some EIM (e.g. pyoderma gangrenosum and primary sclerosing cholangitis) may or may not be associated with the underlying IBD. Successful therapy of EIM is important for improving quality of life of IBD patients. TNF antibody therapy is an important treatment option for EIM in IBD patients whereas no such beneficial effect was reported for alpha 4 beta 7 integrin antibodies such as vedolizumab so far. This article reviews the therapeutic experience with TNF antibodies for the treatment of EIM in IBD patients.