Comparative efficacy of biologics in resolving extraintestinal manifestations of inflammatory bowel disease (IBD): a systematic review and meta-analysis

Comparative efficacy of biologics in resolving extraintestinal manifestations of inflammatory bowel disease (IBD): a systematic review and meta-analysis

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The inflammatory bowel diseases (IBD) are a group of heterogeneous diseases of the digestive system. Over 1 million individuals are estimated to have IBD in the United States with direct medical costs calculated to exceed $6 billion. The most common forms of IBD are Crohn's disease (CD) and ulcerative colitis (UC). Although both forms of IBD are characterized by inflammation of the digestive tract, there are several features that distinguish one from the other. CD tends to commonly affect the terminal ileum, which is the final segment of the small intestine before it reaches the colon. In addition, CD can also affect any segment of the digestive tract from the mouth to the anus. On the other hand, UC is usually limited to the colon and rarely affects any other segment of the digestive tract. Unfortunately, IBD is not limited to the digestive system. Many patients with IBD also suffer from systemic complications or extraintestinal manifestations (EIMs). This includes inflammation of the joints, skin, and eyes. EIMs are relatively common, as they are present in approximately 38 - 41% of patients with IBD. In addition, EIMs have been shown to affect the quality of life. Understanding the best way to manage these complications is important because inefficient management of IBD can lead to increased costs and unwanted complications.Many clinical trials have demonstrated the efficacy of a group of drugs known as biologics in reducing intestinal inflammation and improving symptoms in patients with moderate-to-severe IBD. Biologic drugs are a group of medications that are obtained from living organisms, including humans, animals, and microorganisms. However, evidence on the efficacy of biologics in resolving EIMs collected in these trials is mostly unpublished or unreported. We propose a systematic review and meta-analysis of randomized controlled trials to compare the efficacy of biologic drugs in resolving EIMs of IBD. We decided to study biologics because patients with moderate-to-severe IBD are usually treated with this class of medications and EIMs are more common in patients with moderate-to-severe IBD. We chose to do a systematic review and meta-analysis because it involves a clear step-by-step process of exploring the scientific literature and collecting all the available evidence to answer our question. As part of this review, we plan to contact study authors and industry sponsors of randomized clinical trials that evaluated the efficacy of biologics in treating intestinal inflammation in IBD for this data. The results from this study will help determine which of the available biologics, if any, is more effective in resolving EIMs in adult patients with IBD that suffer from these complications.

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