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Background: Data on the effects of vedolizumab on joint manifestations remain controversial.1,2
Objectives: The purpose of this study was to1 evaluate baseline characteristics of crohn’s disease (CD) and ulcerative colitis (UC) patients treated with vedolizumab,2 assess the effect of vedolizumab on joint manifestations in patients with inflammatory bowel disease (IBD)-associated Spondyloarthritis (SpA), and3 evaluate new onset of SpA under VDZ.
Methods: This single-centre, retrospective and observational study was conducted from July 2014 to July 2017. The charts of all patients with IBD who had undergone treatment with vedolizumab for more than 3 months were reviewed. The patients’ demographic and clinical characteristics were collected. Data on IBD-associated SpA were collected as well as new onset of SpA under VDZ. The ASAS criteria were used to establish the diagnosis of SpA.
Results: Patient characteristics and main results are shown in table 1. A total of 171 patients diagnosed with IBD were treated with vedolizumab from July 2014 to July 2017. Notably, 97.1% of patients had been previously treated with at least one TNF-α inhibitor. All patients included in this study completed the induction phase at last observation, and the mean follow-up of the entire cohort was 14.3±12.0 months. Ten (5.8%) patients had a history of IBD-associated SpA but were in clinical remission at the time of initiation of VDZ, whereas 4 (2.4%) had active SpA when VDZ was started. First, no clinical benefit on SpA following initiation of VDZ was found in those 4 patients with active SpA. Second, exacerbation of SpA in patients with clinical remission at initiation of VDZ was found in 6/10 patients whereas no effect was reported in the remaining 4/10 patients. All those 14 patients with IBD-associated SpA were under TNF inhibitors just before starting VDZ. Finally, new onset of SpA induced by VDZ was reported in 1 patient.
Variable |
n=171 |
|---|---|
Age (years), mean±SD |
37.8±12.9 |
Female gender, n (%) |
110 (64.3) |
Body mass index (kg/m²), mean±SD |
23.7 (4.8) |
Type of disease, n (%) |
104 (60.8) |
- Crohn’s disease |
67 (39.2) |
- Ulcerative colitis |
|
Duration of disease (years), mean±SD |
10.5 (7.6) |
Duration of follow-up under vedolizumab (months), mean±SD |
14.3 (12.0) |
IBD-associated SpA, n (%) |
157 (91.8) |
- No history |
10 (5.8) |
- History (inactive at initiation of VDZ) |
4 (2.4) |
- Active at initiation of VDZ |
|
Clinical benefit on SpA following initiation of VDZ (n=4) |
4/4 (100) |
- No clinical benefit |
0/4 (0) |
- Improvement |
|
Exacerbation of SpA in patients with clinical remission at initiation of VDZ (n=10) |
6 (60) |
- Yes |
4 (40) |
- No |
|
New onset of SpA induced by VDZ |
1 (<1) |
Conclusions: Vedolizumab does not seem to show any efficacy in IBD-associated SpA and might even induce exacerbation or new onset of SpA. Inception cohort studies are needed to better evaluate the effect of vedolizumab on joint manifestations.
References
Disclosure of Interest: None declared
DOI: 10.1136/annrheumdis-2018-eular.3068