Ustekinumab for Extra-intestinal Manifestations of Inflammatory Bowel Disease: A Systematic Literature Review

J Crohns Colitis. 2021 Jul 5;15(7):1236-1243. doi: 10.1093/ecco-jcc/jjaa260.

Lucas Guillo 1 2, Ferdinando D'Amico 3 4, Silvio Danese 3 4, Laurent Peyrin-Biroulet 2


Author information

  • 1Department of Gastroenterology, University Hospital of Marseille Nord, University of Aix-Marseille, Marseille, France.
  • 2Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France.
  • 3Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
  • 4Department of Gastroenterology, Humanitas Clinical and Research Centre - IRCCS, Rozzano Milan, Italy.


Background and aims: Extra-intestinal manifestations [EIMs] are frequent in patients with inflammatory bowel diseases [IBD] and are challenging conditions to manage. Tumour necrosis factor alpha antagonists [anti-TNFα] are recognised as the primary therapeutic option. We aimed to summarise evidence on the efficacy of ustekinumab for the treatment of EIMs.

Methods: We searched in PubMed, Cochrane Library, and Web of Science, up to October 2020, all interventional and non-interventional studies published in English and assessing ustekinumab efficacy for the treatment of EIMs.

Results: Nine studies [eight retrospective and one prospective] were included, enrolling a total of 254 patients with IBD and EIM. Ustekinumab showed its effectiveness for arthralgia and psoriatic arthritis in 152 patients through three high-quality studies. Conversely, no efficacy was found in axial spondyloarthritis. Psoriasis, pyoderma gangrenosum, and erythema nodosum were assessed in seven studies including 65 patients and showed high response rate to ustekinumab treatment. Promising results for aphthous stomatitis and uveitis were reported, but data were limited to 20 patients from two studies.

Conclusions: Ustekinumab showed to be an effective option for the treatment of EIMs, especially for dermatological and rheumatological manifestations. However, more data are needed to confirm the role of ustekinumab in this setting.

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