P400 Anti-TNF treatment for extraintestinal manifestations of inflammatory bowel disease in the Swiss IBD Cohort Study
T. Greuter*1, L. Biedermann1, G. Rogler1, E. Safroneeva2, A. Schoepfer3, S. Vavricka1, 4
1University Hospital Zurich, Division of Gastroenterology and Hepatology, Zurich, Switzerland, 2University of Bern, Institute of Social and Preventive Medicine, Bern, Switzerland, 3University Hospital Lausanne - CHUV, Division of Gastroenterology and Hepatology, Lausanne, Switzerland, 4Triemli Hospital Zurich, Division of Gastroenterology and Hepatology, Zurich, Switzerland
Extraintestinal manifestations (EIM) in inflammatory bowel disease (IBD) patients are frequently observed. However, little is known about the efficacy of anti-TNF treatment in EIM and current recommendations are largely based on expert opinions and case reports. We aimed to assess the effect of 3 anti-TNF agents (infliximab, adalimumab and certolizumab pegol) on the evolution of EIM.
Data from the Swiss Inflammatory Bowel Disease Cohort Study (SIBDCS) with 1 249 patients enrolled between January 2006 and March 2010 were analysed.
Of the 366 patients with at least 1 EIM, 213 (58.2%) had been treated with an anti-TNF, most of them with 1 anti-TNF agent (n = 147, 69.0%). Of these, 36.2% were male; 77.5% had Crohn’s disease (CD); 18.8% ulcerative colitis (UC); and 2.8% indeterminate colitis (IC). Mean age at IBD diagnosis was 27.9 years (4.0–61.5) with a mean age of 44.4 years (20.5–78.2) at enrolment into the SIBDCS. The most frequently reported EIM were peripheral arthritis (75.6%), aphtous stomatitis (23.5%) and axial arthropathy/ankylosing spondylitis (21.6%). Infliximab was used in 63.2%, adalimumab in 22.4% and certolizumab pegol in 14.4% of patients. More than half of the patients showed a clinical response of the underlying EIM to anti-TNF therapy (54.5%). Under infliximab, peripheral arthritis had a clinical response rate of 77.6%, whereas aphtous stomatitis improved in 77.8%, uveitis in 66.7% and axial arthropathy in 59.1% of patients. Erythema nodosum showed a clinical response in 88.9% of patients. Improvement rates for the subcutaneous agents (adalimumab and certolizumab) were comparable. Only in 4.7% of patients (n = 10), EIM presented under anti-TNF treatment for the first time with most of them (69.2%) showing an improvement under continued anti-TNF therapy.
Anti-TNF therapy has a positive effect on most EIM. Occurrence of EIM under anti-TNF is seldom encountered and in only a minority a worsening of the underlying EIM can be observed. Anti-TNF agents are a valuable treatment for EIM.