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. 2020 Feb;16(2):75-81.

Vedolizumab-Induced De Novo Extraintestinal Manifestations

Liege I Diaz  1   2   3   4   5   6 , Tara Keihanian  1   2   3   4   5   6 , Ingrid Schwartz  1   2   3   4   5   6 , Su Bin Kim  1   2   3   4   5   6 , Fernando Calmet  1   2   3   4   5   6 , Maria Alejandra Quintero  1   2   3   4   5   6 , Maria T Abreu  1   2   3   4   5   6
Affiliations

Vedolizumab-Induced De Novo Extraintestinal Manifestations

Liege I Diaz et al. Gastroenterol Hepatol (N Y). 2020 Feb.

Abstract

Background: Vedolizumab is an α4β7 integrin antagonist with gut-specific effects on lymphocyte and monocyte trafficking. Although the treatment is beneficial for inflammatory bowel disease (IBD), the effects of vedolizumab on extraintestinal manifestations (EIMs) have not been well described. The gut-specific effects of the medication may have diverse outcomes on EIMs. We hypothesize that EIMs may be unmasked by systemic availability of gut-homing effector cells. Aim: The goal of this study is to describe de novo EIMs of IBD patients who were started on vedolizumab. Methods: A retrospective chart review of 71 patients from January 2011 to October 2017, including clinical and medication history and colonoscopy results, was performed. Results: EIMs occurred in 26.7% of patients who were started on vedolizumab. The most common EIMs were arthralgias, perianal fistula, and pyoderma gangrenosum. There was a trend toward a greater occurrence of EIMs in patients with Crohn's disease compared to ulcerative colitis. Conclusion: Our retrospective study suggests that inhibition of gut-specific effector cells results in activated lymphocytes and/or monocytes that cause inflammation in other tissues. More studies are needed to confirm these observations and to develop biomarkers that predict patients at risk for EIMs and perianal fistulas while on vedolizumab.

Keywords: Vedolizumab; arthralgia; extraintestinal manifestations; inflammatory bowel disease; perianal disease.

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Conflict of interest statement

Dr Abreu has received grant/research support from Prometheus Laboratories, Takeda, Eli Lilly Pharmaceuticals, and Pfizer. She has served as a consultant for AbbVie Laboratories, Prometheus Laboratories, Takeda, Janssen Pharmaceuticals, Focus Medical Communications, Celgene Corporation, Eli Lilly Pharmaceuticals, Pfizer, Shire Pharmaceuticals, Roche Pharmaceuticals, Boehringer Ingelheim Pharmaceuticals, Amgen, Gilead, and Allergan. She has also served on the speakers bureau for Takeda and Focus Medical Communications. The other authors have no relevant conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
EIM-free survival according to the type of inflammatory bowel disease. CD, Crohn’s disease; EIM, extraintestinal manifestation; UC, ulcerative colitis.
Figure 2.
Figure 2.
EIM-free survival according to the type of inflammatory bowel disease in the subgroup of patients with no prior EIMs. CD, Crohn’s disease; EIM, extraintestinal manifestation; UC, ulcerative colitis.
See this image and copyright information in PMC

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