Treatment of Inflammatory Bowel Disease with Biologics

55

Conclusion

Anti-TNFs provide a valuable tool for the treatment of multiple EIM of IBD,
although the data supporting their use are mostly retrospective and lack significant
numbers of UC patients. With these limitations in mind, this class of biologics
appears to be effective for the treatment of IBD-associated peripheral and axial
arthritis as well as pyoderma gangrenosum. Outside of IBD, anti-TNF agents
appear effective for uveitis, and, although there is limited data regarding uveitis
specifically in IBD patients, its use is reasonable in refractory cases. Bone density
may improve with anti-TNF therapy as well, but the data is still insufficient to
recommend it for this indication alone. Some conditions, such as PSC, do not ben-
efit from the use of anti-TNFs. Finally, it is important to recognize that anti-TNF
drugs can cause “paradoxical” manifestations, such as PG or EN, that remit with
withdrawal of the medication; this, however, does not seem to be a class effect.
Future studies—ideally with a randomized control design and sufficient UC
patients—are needed to enrich the current evidence and enhance our ability to
manage these difficult patients.

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4 Anti-TNF Therapy for Treatment of Extraintestinal Manifestations of Inflammatory