P1134 The effectiveness of medical therapies for dermatological extraintestinal manifestations in patients with IBD: an umbrella review
Bibliographic record
Abstract
Abstract Background Patients with IBD can develop various extraintestinal manifestations (EIMs), including those affecting the skin. These dermatological EIMs may or may not mimic the disease course of the underlying IBD, can have a significant impact on quality of life for patients and a major influence on treatment decisions. We conducted an overview of systematic reviews (umbrella review) to assess the effectiveness and safety of medical treatments for managing dermatological EIMs in patients with IBD. Methods In this umbrella review, we searched major databases (MEDLINE, Embase and Cochrane CDSR,) for relevant systematic reviews published until May 2024, that aimed to review the medical interventions of the dermatological EIMs. Screening, data extraction, and quality appraisal (using AMSTAR 2) were performed by at least two reviewers and any discrepancies resolved by a third independent reviewer. Results Of 1436 screened papers, 11 systematic reviews met our inclusion criteria. These 11 systematic reviews evaluated the effect of medical therapies across five dermatological EIMs in patients with IBD, with some systematic reviews considering more than one EIM: psoriasis (n=2), erythema nodosum (n=3), pyoderma gangrenosum (n=7), Sweet’s syndrome (n=1) and cutaneous vulval Crohn’s disease (n=1) (Table 1). For psoriasis, low response (14%) was reported to methotrexate but with high levels of remission with ustekinumab (82%), and no additional benefit of methotrexate combination with ustekinumab. For erythema nodosum, high levels of response were reported for anti-TNF therapies (80-100%), vedolizumab (50-62%) and ustekinumab (70%). For pyoderma gangrenosum, a more variable response was reported for anti-TNF therapies (21-92%), vedolizumab (33%) and ustekinumab (75%). For Sweet’s syndrome corticosteroids were reported to be effective in most, with limited data on more advanced therapies. For cutaneous vulval Crohn’s disease metronidazole was associated with 23% complete healing with limited data on more advanced therapies. There were no published systematic reviews on effectiveness of IL-23 specific p40 antagonists or oral small molecules. Effectiveness data was mostly descriptive and generally high levels of response were reported to the above treatments. Overall the certainty in the results of the reviews was low. Conclusion Although dermatological manifestations are common for patients with IBD, the evidence-base for medical interventions to treat these dermatological EIMs is limited and heterogeneous. These results outline the need for dedicated research studies to better determine the effectiveness and safety of medical therapies to treat dermatological manifestations specifically in patients with IBD.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.018 | 0.088 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.010 | 0.009 |
| Bibliometrics | 0.018 | 0.015 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.004 | 0.004 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".