{
  "abstract": "Management of extraintestinal manifestations (EIMs) and concomitant immune-mediated inflammatory diseases (IMIDs) in patients with inflammatory bowel disease (IBD) represents a significant clinical challenge, often requiring the combination of advanced therapies to achieve adequate disease control. This review aims to provide a comprehensive and practical framework for the implementation of dual advanced therapy (DAT) in this complex patient population.We performed a narrative review of randomised trials, real-world cohorts and case series on combinations of biologics and small molecules in IBD with EIMs/IMIDs, appraising mechanistic complementarity, safety and economic implications.Although evidence remains limited, DAT appears appropriate for selected profiles: refractory IBD with active EIMs, concomitant IMIDs with divergent tissue responses and ‘bridge’ strategies during class switching. Combinations leveraging non-overlapping pathways (eg, anti-tumour necrosis factor with vedolizumab or ustekinumab; Janus Kinase (JAK) inhibitors with gut-selective or cytokine-targeted agents) are most promising. We outline monitoring targets by domain and a safety checklist (infections, malignancy, thromboembolism, vaccination).This review translates heterogeneous data into a pragmatic Who/What/When/Cost framework to guide DAT in IBD with EIMs/IMIDs and delineates research priorities for cross-organ outcomes and long-term safety.",
  "authors": [
    {
      "affiliations": [
        "Gastroenterology and Hepatology department, Reina Sofía University Hospital.IMIBIC. University of Córdoba, Cordoba, Spain",
        "CIBERehd. Instituto Carlos III, Madrid, Spain"
      ],
      "name": "Beatriz Gros"
    },
    {
      "affiliations": [
        "Rheumatology, University Hospital Ghent, Ghent, Flanders, Belgium",
        "University of Ghent Department of Internal Medicine and Pediatrics, Ghent, Flanders, Belgium"
      ],
      "name": "Gaëlle Varkas"
    },
    {
      "affiliations": [
        "Dermatology, University Hospital Ghent, Ghent, Flanders, Belgium"
      ],
      "name": "Reinhart Speeckaert"
    },
    {
      "affiliations": [
        "University of Ghent Department of Internal Medicine and Pediatrics, Ghent, Flanders, Belgium",
        "Gastroenterology, University Hospital Ghent, Ghent, Flanders, Belgium"
      ],
      "name": "Triana Lobaton"
    }
  ],
  "title": "Combining advanced therapies in patients with inflammatory bowel disease and extraintestinal manifestations or associated immune-mediated diseases: who, what, when and at what cost?",
  "uid": "4a3467a3-618d-568b-a166-f292c65df62f"
}