G Varkas1,2, K Thevissen1,3, G De Brabanter4, L Van Praet1, F Czul-Gurdian5, H Cypers1,2, J De Kock1, P Carron1,3, M De Vos6, P Hindryckx6, J Arts7, I Vanneuville3, P Schoenaers8, B Claerhout8, M Abreu5, F Van den Bosch1, D Elewaut1,2. 1. Department of Rheumatology, Ghent University Hospital, Ghent, Belgium. 2. VIB Inflammation Research Center, Ghent University, Ghent, Belgium. 3. Department of Rheumatology/Physical medicine and rehabilitation, AZ Alma, Sijsele-Eeklo, Belgium. 4. Department of Rheumatology, AZ Sint-Lucas Brugge, Bruges, Belgium. 5. The Crohn's and Colitis Center, Miller School of Medicine, University of Miami, Miami, Florida, USA. 6. Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium. 7. Department of Gastroenterology, AZ Sint-Lucas Brugge, Bruges, Belgium. 8. Department of Gastroenterology, AZ Alma, Sijsele-Eeklo, Belgium.
Abstract
BACKGROUND: In inflammatory bowel disease (IBD), a new biological therapy has recently been approved. Vedolizumab is a humanised IgG1 monoclonal antibody to α4β7 integrin that modulates gut lymphocyte trafficking. Although an exclusively local effect of vedolizumab could be expected based on the restricted presence of the α4β7-mucosal vascular addressin cell adhesion molecule 1 complex in the gut, past combined success with anti-tumour necrosis factor, and previous demonstration of α4β7 integrin in the joint, led to the expectation of a therapeutic efficacy in spondyloarthritis. Nonetheless, the effect of vedolizumab on extraintestinal manifestations-and especially the joint-has not been reported so far. CASE REPORT: A series of five patients with IBD who were treated with vedolizumab and promptly developed new onset or exacerbation of sacroiliitis or arthritis are reported. CONCLUSIONS: Vedolizumab therapy does not seem to show any efficacy in and might even induce arthritis and/or sacroiliitis. However, larger cohort studies are needed to provide information on the prevalence, the evolution and underlying mechanism. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
BACKGROUND: In inflammatory bowel disease (IBD), a new biological therapy has recently been approved. Vedolizumab is a humanised IgG1 monoclonal antibody to α4β7 integrin that modulates gut lymphocyte trafficking. Although an exclusively local effect of vedolizumab could be expected based on the restricted presence of the α4β7-mucosal vascular addressin cell adhesion molecule 1 complex in the gut, past combined success with anti-tumour necrosis factor, and previous demonstration of α4β7 integrin in the joint, led to the expectation of a therapeutic efficacy in spondyloarthritis. Nonetheless, the effect of vedolizumab on extraintestinal manifestations-and especially the joint-has not been reported so far. CASE REPORT: A series of five patients with IBD who were treated with vedolizumab and promptly developed new onset or exacerbation of sacroiliitis or arthritis are reported. CONCLUSIONS:Vedolizumab therapy does not seem to show any efficacy in and might even induce arthritis and/or sacroiliitis. However, larger cohort studies are needed to provide information on the prevalence, the evolution and underlying mechanism. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Entities:
Keywords:
Arthritis; Inflammation; Magnetic Resonance Imaging; Spondyloarthritis; Treatment
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