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Anti-TNF Treatment for Extraintestinal Manifestations of Inflammatory Bowel Disease in the Swiss IBD Cohort Study

Vavricka, Stephan R. MD1,2; Gubler, Martin MD1; Gantenbein, Claudine MD1; Spoerri, Muriel MD1; Froehlich, Florian MD3,4; Seibold, Frank MD5; Protic, Marijana MD6; Michetti, Pierre MD7; Straumann, Alex MD8; Fournier, Nicolas PhD9; Juillerat, Pascal MD, MSc10; Biedermann, Luc MD2; Zeitz, Jonas MD2; Misselwitz, Benjamin MD2; Scharl, Michael MD2; Heinrich, Henriette MD2; Manser, Christine N. MD2,11; Safroneeva, Ekaterina PhD12; Raja Ali, Raja Affendi MD13; Rogler, Gerhard MD, PhD2; Schoepfer, Alain M. MD4; Greuter, Thomas MD2Swiss IBD Cohort Study Group

doi: 10.1097/MIB.0000000000001109
Original Clinical Articles

Background: Extraintestinal manifestations (EIMs) in patients with inflammatory bowel disease (IBD) are frequently observed. Little is known about the efficacy of anti–tumor necrosis factor (TNF) in EIM management. We assessed the effect of 3 anti-TNF agents (infliximab, adalimumab, and certolizumab pegol) on EIM evolution.

Methods: Data on 1249 patients from the Swiss IBD Cohort Study (SIBDCS) were analyzed. All EIMs were diagnosed by relevant specialists. Response was classified into improvement, stable disease, and clinical worsening based on the physician's interpretation.

Results: Of the 366 patients with at least 1 EIM, 213 (58.2%) were ever treated with an anti-TNF. A total of 299 treatments were started for 355 EIMs. Patients with EIM were significantly more often treated with anti-TNF compared with those without EIM (58.2% versus 21.0%, P < 0.001). Infliximab was the most frequently used drug (63.2%). In more than 71.8%, a clinical response of the underlying EIM to anti-TNF therapy was observed. In 92 patients (43.2%), anti-TNF treatments were started for the purpose of treating EIM rather than IBD. Response rates to anti-TNF were generally good and best for psoriasis, aphthous stomatitis, uveitis, and peripheral arthritis. In 11 patients, 14 EIM occurred under anti-TNF treatment.

Conclusions: Anti-TNF was frequently used among patients with EIM. In more than 40%, anti-TNF treatments are started to treat EIM rather than IBD. Given the good response rates, anti-TNF seems to be a valuable option in the treatment of EIM, whereas appearance of EIM under anti-TNF does not seem to be a source of considerable concern.

Article first published online 27 April 2017.Supplemental Digital Content is Available in the Text.

1Division of Gastroenterology and Hepatology, Triemli Hospital Zurich, Zurich, Switzerland;

2Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland;

3Division of Gastroenterology and Hepatology, University Hospital Basel, Basel, Switzerland;

4Division of Gastroenterology and Hepatology, University Hospital Lausanne—CHUV, Lausanne, Switzerland;

5Division of Gastroenterology, Lindenhof Spital, Bern, Switzerland;

6Division of Gastroenterology and Hepatology, Spital Tiefenau, Bern, Switzerland;

7Crohn and Colitis Center, Clinique La Source-Beaulieu, Lausanne, Switzerland;

8Praxis Römerhof, Olten, Switzerland;

9Institute of Social and Preventive Medicine (IUMSP), University of Lausanne, Lausanne, Switzerland;

10Department of Gastroenterology, Clinic for Visceral Surgery and Medicine, Inselspital, University Hospital of Bern, Bern, Switzerland;

11Department of Gastroenterology, See Spital, Horgen, Switzerland;

12Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland; and

13Division of Gastroenterology, The National University of Malaysia Medical Centre, Kuala Lumpur, Malaysia.

Address correspondence to: Stephan R. Vavricka, MD, Division of Gastroenterology and Hepatology, Triemli Hospital Zurich, Birmensdorferstrasse 497, 8063 Zurich, Switzerland (e-mail:

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Supported by a research grant from the Swiss National Science Foundation to GR (The Swiss IBD Cohort Study [Grant No. 3347CO-108792]).

The authors have no conflict of interest to disclose.

S. R. Vavricka and M. Gubler share co-first authorship. A. M. Schoepfer and T. Greuter share co-last authorship.

Swiss IBD Cohort Study Group Members are listed in Appendix 1.

Received October 25, 2016

Accepted February 28, 2017

© Crohn's & Colitis Foundation
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