Marie Truyens, Xenia Tolstoy, Giulio Calabrese, Anneline Cremer, Konrad Lewandowski, Konstantinos Argyriou, Ioannis Drygiannakis, Eathar Shakweh, Ploutarchos Pastras, Haluk Tarik Kani, María José García, Hannah Gordon, Davide Giuseppe Ribaldone, Konstantinos Karmiris, Carla Felice, Irene Moraleja Yudego, Andreas Blesl, Alessia Todeschini, Paola Balestrieri, Rafal Filip, Thibault Taelman, Nora Vladimirova, Georgios Michalopoulos, Mohamed Attauabi, Lieven Pouillon, Nurulamin Noor, Tommaso Innocenti, Sophie Vieujean, Tarkan Karakan, Manuel Barreiro-de Acosta, Giammarco Mocci, Maria Manuela Estevinho, Edoardo Vincenzo Savarino, Aranzazu Jauregui-Amezaga, Tom Holvoet, Christina Kapizioni, Gizem Dagci, Spyridon Vrakas, Charlotte R H Hedin, Olga Maria Nardone, Grażyna Rydzewska, Ioannis Koutroubakis, Ioannis Psaroudakis, Gabriele Dragoni, Jeroen Geldof, Gaëlle Varkas, Jo Lambert, Triana Lobatón
JAK inhibitors were associated with favorable physician-assessed outcomes for EIMs/IMIDs in treatment-experienced IBD patients. Co-existing axial and peripheral SpA was associated with treatment discontinuation, suggesting a more complex phenotype.
BACKGROUND AND AIMS: Extraintestinal manifestations (EIMs) and immune-mediated inflammatory diseases (IMIDs) are common in inflammatory bowel diseases (IBD) and contribute substantially to morbidity. The aim was to evaluate the real-world effectiveness of JAK inhibitors on EIMs/IMIDs.
METHODS: This multicenter retrospective study included adults with ulcerative colitis (UC) or Crohn's disease (CD) and one or more EIM/IMID initiating a JAK inhibitor (tofacitinib, upadacitinib, or filgotinib). Baseline was defined as treatment initiation; EIM/IMID and IBD activity were assessed at fixed timepoints using physician global assessment. Response rates are reported as observed, with patients discontinuing for worsening of the manifestation counted as non-responders. Logistic and Cox regression analyses identified factors associated with response and treatment discontinuation.
RESULTS: A total of 246 patients were included; 67% had two or more prior advanced therapies. Peripheral spondyloarthritis (SpA) (48%) and axial SpA (43%) were the most prevalent EIMs/IMIDs. Peripheral SpA response rates were 82% post-induction and 74% at month 12; axial SpA response rates were 71% and 59%, respectively. Psoriasis response was observed in 65% post-induction and in 50% at month 12, and hidradenitis suppurativa response in 91% and 78%, respectively. Steroid-free clinical IBD remission was 58% at month 12, and was independently associated with peripheral SpA response (adjusted odds ratio [aOR] 4.2, 95% CI 1.2-14.7). Treatment was discontinued in 31%; factors associated with discontinuation were filgotinib use (adjusted hazard ratio [aHR] 3.0, 95% CI 1.4-6.2) and co-existing axial and peripheral SpA (aHR 2.8, 95% CI 1.5-5.1).
CONCLUSIONS: JAK inhibitors were associated with favorable physician-assessed outcomes for EIMs/IMIDs in treatment-experienced IBD patients. Co-existing axial and peripheral SpA was associated with treatment discontinuation, suggesting a more complex phenotype.