AUTHOR=Ferretti Francesca , Monico Maria Camilla , Cannatelli Rosanna , Carmagnola Stefania , Lenti Marco Vincenzo , Di Sabatino Antonio , Conforti Francesco , Pastorelli Luca , Caprioli Flavio , Bezzio Cristina , Saibeni Simone , Mazza Stefano , Vecchi Maurizio , Maconi Giovanni , Ardizzone Sandro 

TITLE=The impact of biologic therapies on extra-intestinal manifestations in inflammatory bowel disease: A multicenter study

JOURNAL=Frontiers in Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2022.933357

DOI=10.3389/fmed.2022.933357

ISSN=2296-858X

ABSTRACT=Introduction
Patients with Inflammatory Bowel Disease [IBD] have a high risk of developing extra-intestinal manifestations [EIMs]. We aimed to assess the cumulative incidence and clinical course of EIMs in patients treated with Vedolizumab [VDZ] and non-gut selective biologic drugs. 
Materials and methods
In this multicenter observational study, we enrolled 1182 IBD patients under biologic treatment in tertiary care centers, collecting the rate of new onset EIMs and the clinical course of new and pre-existing EIMs since the introduction of the ongoing biologic drug [259 VDZ versus 923 non-gut selective agents, median time 3 vs 4 years]. 
Results
Among 1182 IBD patients [median age 46 years; 55% males] on biologics, the overall cumulative incidence of new onset EIMs was 4.1% [49/1182], in particular 6.6% [17/259] on VDZ vs 3.5% [32/923] on non-gut selective biologics [p = 0.02]. Amongst 224 patients reporting a new or pre-existing EIMs, those on VDZ showed a higher rate of clinical worsening compared to non-gut selective therapies [15.5% vs 7.3%, p = 0.08]. However, both showed a similar rate of modification of the therapeutic regimen. Female gender [HR 2.18], a longer course of the ongoing biologic therapy [HR 1.18], UC [HR 1.83] and VDZ therapy [HR 1.85] resulted to be significant risk factors of developing new EIMs.
Discussion
Our study suggests that the type of biologic treatment might affect the risk of developing EIMs, with a slightly higher risk in patients on gut-selective therapies. However, a similar clinical course is observed in the two groups.