Gut. 2020 Aug 26;gutjnl-2020-322129. doi: 10.1136/gutjnl-2020-322129.Online ahead of print.

Thomas Greuter ^1 2, Florian Rieder ³, Torsten Kucharzik ⁴, Laurent Peyrin-Biroulet ⁵, Alain M Schoepfer ^6 7, David T Rubin ⁸, Stephan R Vavricka ^1 9

Author information

• ¹Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland stephan.vavricka@usz.ch th_greuter@bluewin.ch.
• ²Department of Internal Medicine, GZO - Zurich Regional Health Center, Wetzikon, Switzerland.
• ³Division of Gastroenterology, Hepatology & Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, United States.
• ⁴Division of Gastroenterology and Hepatology, Klinikum Lueneburg, Lueneburg, Germany.
• ⁵Inserm U954, Department of Hepato-Gastroenterology, University Hospital of Nancy, Université Henri Poincaré 1, Vandoeuvre-lès-Nancy, France.
• ⁶Division of Gastroenterology and Hepatology, University Hospital Lausanne - CHUV, Lausanne, Switzerland.
• ⁷University of Lausanne, Lausanne, Switzerland.
• ⁸Inflammatory Bowel Disease Center, University of Chicago, Chicago, IL, United States.
• ⁹Gastroenterology and Hepatology Center, Zurich, Switzerland.

Abstract

Extraintestinal manifestations (EIMs) are frequently observed in IBDs and contribute considerably to morbidity and mortality. They have long been considered a difficult to treat entity due to limited therapy options, but the increasing use of anti-tumour necrosis factors has dramatically changed the therapeutic approach to EIM in recent years. Newly emerging therapies such as JAK inhibitors and anti-interleukin 12/23 will further shape the available armamentarium. Clinicians dealing with EIMs in everyday IBD practice may be puzzled by the numerous available biological agents and small molecules, their efficacy for EIMs and their potential off-label indications. Current guidelines on EIMs in IBD do not include treatment algorithms to help practitioners in the treatment decision-making process. Herein, we summarise knowledge on emerging biological treatment options and small molecules for EIMs, highlight current research gaps, provide therapeutic algorithms for EIM management and shed light on future strategies in the context of IBD-related EIMs.