Ustekinumab for extra-intestinal manifestations of inflammatory bowel disease: a systematic literature review.

BACKGROUND AND AIMS:

Extraintestinal manifestations (EIMs) are frequent in patients with inflammatory bowel diseases (IBD) and a challenging condition to manage. Tumor necrosis factor alpha antagonists (anti-TNFα) are recognized as the primary therapeutic option. We aimed to summarize 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 assessing ustekinumab efficacy for the treatment of EIMs.

RESULTS:

Nine studies (8 retrospective and 1 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 3 high quality studies. Conversely, no efficacy was found in axial spondyloarthritis. Psoriasis, pyoderma gangrenosum and erythema nodosum were assessed in 7 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 2 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.