| Title: |
Effect of IL-23 inhibitors on extra-intestinal manifestations and concurrent immune-mediated inflammatory diseases in patients with inflammatory bowel disease. |
| Authors: |
Truyens, M.1,2; Tolstoy, X.3; Calabrese, G.4; Balestrieri, P.5; Blesl, A.6; Pouillon, L.7; Shakweh, E.8,9; Filip, R.10,11; Todeschini, A.12; Mocci, G.13; Ribaldone, D. G.14,15; Jauregui-Amezaga, A.16,17; Moraleja-Yudego, I.18; Vieujean, S.19; Taelman, T.20,21; García, M. J.22; Cremer, A.23; Savarino, E. V.24,25; Felice, C.26,27; Vladimirova, N.28 |
| Source: |
Journal of Crohn's & Colitis. 2026 Supplement, Vol. 20, pi2069-i2073. 5p. |
| Abstract: |
Background: Immune-mediated inflammatory diseases (IMIDs) and extra-intestinal manifestations (EIMs) are frequent in IBD and contribute substantially to morbidity. In recent years, IL-23 inhibitors have shown efficacy in IBD and in dermatological IMIDs such as psoriasis, while their benefit in rheumatological manifestations, particularly axial spondyloarthritis (SpA), appears limited. Real-world data on the effect of IL-23 inhibitors are therefore needed to guide their optimal positioning within IBD management. Methods: This multicentric retrospective cohort included adult patients with ulcerative colitis (UC) or Crohn’s disease (CD) who initiated an IL-23 inhibitor (risankizumab, mirikizumab or guselkumab) for IBD and had at least one EIM or IMID at baseline. IBD and EIM/IMID activity were assessed after induction (week 6–14), at month 6 and at month 12 using physician’s global assessment. IBD outcomes included clinical, biochemical and endoscopic remission. Treatment discontinuation due to primary non-response (PNR), loss of response (LOR) or surgery was classified as non-remission. The primary endpoint was EIM/IMID response while secondary endpoints included steroid-free IBD remission and new-onset of EIMs/IMIDs. Results: In total 83 patients were included (Table 1), with a median follow-up duration of 6 months (IQR 3-10). Steroid-free clinical remission was achieved in 23.9% post-induction and increased to 48% at 12 months (Figure 1). Psoriasis and hidradenitis suppurativa were active at baseline in 70% and 43% of patients, with response rates of 52% and 46% post-induction and 70% and 50% at 12 months respectively. At baseline, axial and peripheral SpA were active in 59% and 81% of cases respectively; response rates reached 47% and 58% post-induction and remained 43% and 50% at 12 months. In 4/22 patients (18.2%) a worsening of axial SpA was seen. Among 58 patients with available follow-up data, 4 (4.1%) developed new-onset EIMs or IMIDs. These included 2 cases of peripheral SpA and 1 case each of psoriasis and uveitis. In 9 patients (10.8%) treatment was discontinued after a median of 8 months (IQR 4.3-10.8). Multiple reasons for treatment discontinuation could be selected and included the following: worsening of the pre-existing EIM/IMID (n=5), LOR (n=3), PNR (n=1) and new onset EIM/IMID (n=1). Conclusion: IL-23 inhibitors demonstrated effectiveness for IBD activity and psoriasis and achieved response rates of approximately 50% in hidradenitis suppurativa, axial and peripheral SpA. New-onset EIMs/IMIDs were uncommon. Interpretation of these outcomes remains limited due to small subgroup sizes, and further studies are needed to better define the role of IL-23 inhibition in IBD patients with coexisting IMIDs. [ABSTRACT FROM AUTHOR] |
| Database: |
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