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Emerging treatment options for extraintestinal manifestations in IBD
  1. Thomas Greuter1,2,
  2. Florian Rieder3,
  3. Torsten Kucharzik4,
  4. Laurent Peyrin-Biroulet5,
  5. Alain M Schoepfer6,7,
  6. David T Rubin8,
  7. Stephan R Vavricka1,9
  1. 1 Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
  2. 2 Department of Internal Medicine, GZO – Zurich Regional Health Center, Wetzikon, Switzerland
  3. 3 Division of Gastroenterology, Hepatology & Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
  4. 4 Division of Gastroenterology and Hepatology, Klinikum Lueneburg, Lueneburg, Germany
  5. 5 Inserm U954, Department of Hepato-Gastroenterology, University Hospital of Nancy, Université Henri Poincaré 1, Vandoeuvre-lès-Nancy, France
  6. 6 Division of Gastroenterology and Hepatology, University Hospital Lausanne – CHUV, Lausanne, Switzerland
  7. 7 University of Lausanne, Lausanne, Switzerland
  8. 8 Inflammatory Bowel Disease Center, University of Chicago, Chicago, IL, USA
  9. 9 Gastroenterology and Hepatology Center, Zurich, Switzerland
  1. Correspondence to Dr Stephan R Vavricka, Gastroenterology and Hepatology Center, Zurich, Switzerland; stephan.vavricka{at}; Dr Thomas Greuter, Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland; th_greuter{at}


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.

  • arthritis
  • IBD clinical
  • TNF

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  • Contributors Concept and design: TG, FR, AMS and SRV; literature review: TG and SRV; elaboration of therapeutic algorithms: TG, FR, TK, LP-B, AMS, DTR and SRV; drafting of manuscript: TG and SRV; critical revision of the manuscript for important intellectual content: FR, TK, LP-B, AMS and DTR. TG and SRV are the guarantors of this study.

  • Funding This work was supported by a grant from the Swiss National Science Foundation to TG (grant no: P2ZHP3_168561) and a research grant from the Novartis Foundation to TG.

  • Competing interests TG has a consulting contract with Sanofi-Aventis, received a travel grant from Falk Pharma and Vifor, and an unrestricted research grant from Novartis. SRV received consultant fees and unrestricted research grants from Abbott, Celtrion, Ferring, MSD, Pfizer, Sanofi-Aventis, Takeda, Tillots, UCB, Vifor and Falk Pharma. FR has consulted with Allergan, AbbVie, Boehringer-Ingelheim, Celgene, Helmsley, Jannsen, Pliant, Receptos, RedX, Roche, Samsung, Takeda, Thetis, UCB and received research grants from Celgene, Pliant and UCB. TK received consultant fees and speaker honoraria from Abbott, Amgen, Biogen, Celtrion, Falk Pharma, Janssen, MSD, Takeda and UCB. LP-B reports personal fees from Merck, Abbvie, Janssen, Ferring, Tillots, Celltrion, Takeda, Pfizer, Amgen, Biogen, Samsung Bioepis, Genentech, Vifor, Pharmacosmos, Biogaran, Boerhinger-Ingelheim, Lilly, Index Pharmaceuticals, Sandoz, Celgene, Alma, Sterna, Nestlé and Enterome. AMS received consulting and/or speaker fees from Abbvie, Adare, Dr Falk Pharma, MSD, UCB, Pfizer, Takeda, Vifor, Receptos, Regeneron and received research grants Adare, Dr Falk Pharma, Receptos and Regeneron. No company representative was involved in conception, writing or financing of this study.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.