Abstract
BACKGROUND: Extraintestinal manifestations (EIMs) significantly impact patients with inflammatory bowel disease (IBD). Janus kinase inhibitors (JAKi) are emerging as a potential treatment. This study describes real-world outcomes in Colombian patients with IBD and EIMs treated with upadacitinib or tofacitinib. METHODS: Multicenter study including moderate-to-severe IBD patients with EIMs. We analyzed the prevalence, resolution, and progression of EIMs with JAKi therapy. RESULTS: Among 77 patients (51 UC-tofacitinib, 16 UC-upadacitinib, 10 CD-upadacitinib), 28.6% (n=22) had EIMs, primarily articular (81.25%), followed by hepatobiliary (25%), cutaneous (18.75%), and ocular (6.25%). Most tofacitinib-UC patients (90%) had prior anti-TNF therapy. During induction, 66.6% had a clinical response, and 33.3% achieved EIM remission. In maintenance, 83.3% achieved remission. Among upadacitinib-UC patients, 66.6% had prior anti-TNF, 33.3% anti-integrin, and 33.3% were biologic-naïve. Corticosteroid use was reduced in 66.7%. Induction response was 66.7%, with 33.3% achieving remission. At six months, remission was 50%. No significant difference in remission rates was observed between upadacitinib and tofacitinib (OR 1.36, 95%CI 0.43-4.33, P=0.28). In CD-upadacitinib, all patients had prior anti-TNF therapy, with 66.6% achieving remission during induction. Adverse events included alopecia, acne, and herpes zoster. CONCLUSION: JAKi therapy is a safe and effective alternative for IBD patients with EIMs. While upadacitinib may offer superior intestinal benefits, both treatments demonstrated efficacy in managing EIMs.