Abstract Background Extraintestinal manifestations (EIMs) contribute substantially to IBD-related morbidity and negatively impact patient quality of life. . This study assessed the incremental risk of developing EIMs in incident IBD patients and in those initiating advanced therapies (AT). Methods We conducted a retrospective cohort study using administrative claims data from the Optum® Market Clarity database (January 1, 2016–March 31, 2025). Two cohorts were identified: (1) incident cases of ulcerative colitis (UC) or Crohn’s disease (CD), and (2) UC and CD patients initiating IBD-approved ATs. Each cohort was propensity score-matched (1:10) to controls from the general patient population. Classical EIMs were defined per the 2024 ECCO guidelines and grouped by organ system. Outcomes included prevalence at anytime, cumulative incidence (CI), incidence rates (IR), and time to first EIM. Cox proportional hazards models were used to compare EIM incidence between cohorts and matched controls. Results Among 50,284 incident IBD cases (UC: 31,632; CD: 18,652) with a mean (SD) follow-up of 3.6 (2.2) years (UC) and 3.5 (2.2) years (CD), EIM prevalence was 22.7% (UC) and 24.6% (CD). Joint and skin-related EIMs were the most common across both diseases. Compared to matched controls, cumulative incidence and incidence rates were higher in IBD patients (UC: 16.2% vs 7.1%; CD: 18.2% vs 6.6%), with hazard ratios (HR 95% CI) of 2.3 (2.23–2.38) for UC and 2.8 (2.79–2.99) for CD. Among 22,442 IBD patients initiating ATs (UC: 9,946; CD: 12,496), the prevalence of EIM was 24.3% (UC) and 26.1% (CD), compared to 8.2% and 7.9% in the control groups. Over a mean follow-up of 2.4 (2.0) years, 15.2% of UC patients (IR: 75.5/1,000 PY) and 16.7% of CD patients (IR: 79.9/1,000 PY) developed new EIMs. The risk of EIMs was approximately four times higher in AT-treated patients (UC: HR 4.06 3.82–4.32; CD: HR 4.46 4.22–4.70). The average time from AT initiation to EIM onset was 1.61 (1.6) years for both UC and CD. Conclusion Patients with IBD have a significantly increased risk of developing EIMs compared to the general population. This elevated risk persists even among those receiving advanced therapies. Reference: Gordon H, Burisch J, Ellul P, et al. ECCO guidelines on extraintestinal manifestations in inflammatory bowel disease. J Crohns Colitis. 2024;18(1):1-37. doi:10.1093/ecco-jcc/jjad108 Conflict of interest: Dubinsky, Marla C: Personal Fees: Consultant or Advisory Board: Abbvie, Abivax, Astra Zeneca, BMS, Celltrion, Gilead, Genentech, Janssen, Johnson and Johnson, Lilly, Merck, Pfizer, Prometheus Biosciences, Sanofi, Spyre, Target RWE, Takeda Other: Shareholder, Co-founder, Board of Directors of Trellus Health Co-Founder Mi Test Health Dr. Alipour Haris, Golnoosh: Employee - USA Merck & Co. Igho-Osagie, Ebuwa: Employee - USA Merck & Co., Chandler, Paulette: Employee - USA Merck & Co. Patel, Nilam: Employee - USA Merck & Co. Lawlor, Garrett: Employee - USA Merck & Co. Rubin, David T.: Grant support: Takeda Pharmaceuticals Consultant: Abbvie, Abivax SA, Altrubio, Athos Therapeutics, Inc, Bristol-Myers Squibb, Celltrion, Connect BioPharma, Eli Lilly & Co., Genentech (Roche) Inc., Iterative Health, Janssen Pharmaceuticals, Johnson & Johnson, Merck & Co., Mirador, Odyssey Therapeutics, Pfizer, Sanofi, Spyre, Takeda Pharmaceuticals, Vedanta Biosciences, and Ventyx.
Dubinsky et al. (Thu,) studied this question.