Liege I Diaz1,2,3,4,5,6, Tara Keihanian1,2,3,4,5,6, Ingrid Schwartz1,2,3,4,5,6, Su Bin Kim1,2,3,4,5,6, Fernando Calmet1,2,3,4,5,6, Maria Alejandra Quintero1,2,3,4,5,6, Maria T Abreu1,2,3,4,5,6. 1. Dr Diaz is an advanced gastroenterology fellow in the Department of Gastrointestinal Oncology at the Moffitt Cancer Center in Tampa, Florida. 2. Dr Keihanian is a gastroenterology fellow in the Department of Internal Medicine in the Division of Gastroenterology at the University of Miami Miller School of Medicine in Miami, Florida. 3. Dr Schwartz is an internal medicine resident in the Department of Internal Medicine at the University of Miami Miller School of Medicine. 4. Dr Kim is a gastroenterology professor in the Department of Internal Medicine in the Division of Gastroenterology at the Cleveland Clinic in Weston, Florida. 5. Dr Calmet is a gastroenterologist in the Department of Internal Medicine in the Division of Gastroenterology at Newton-Wellesley Hospital in Boston, Massachusetts. Ms Quintero is a research program manager at the Crohn's & Colitis Center in Miami, Florida. 6. Dr Abreu is director of the Crohn's & Colitis Center and professor of medicine and of microbiology and immunology in the Department of Internal Medicine in the Division of Gastroenterology at the University of Miami Miller School of Medicine.
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.
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 IBDpatients 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.
Authors: Joseph Meserve; Satimai Aniwan; Jenna L Koliani-Pace; Preeti Shashi; Aaron Weiss; David Faleck; Adam Winters; Shreva Chablaney; Gursimran Kochhar; Brigid S Boland; Siddharth Singh; Robert Hirten; Eugenia Shmidt; Justin G Hartke; Prianka Chilukuri; Matthew Bohm; Sashidhar Varma Sagi; Monika Fischer; Dana Lukin; David Hudesman; Shannon Chang; Youran Gao; Keith Sultan; Arun Swaminath; Nitin Gupta; Sunanda Kane; Edward V Loftus; Bo Shen; Bruce E Sands; Jean-Frederic Colombel; Corey A Siegel; William J Sandborn; Parambir S Dulai Journal: Clin Gastroenterol Hepatol Date: 2018-09-27 Impact factor: 11.382
Authors: S Tadbiri; L Peyrin-Biroulet; M Serrero; J Filippi; B Pariente; X Roblin; A Buisson; C Stefanescu; C Trang-Poisson; R Altwegg; P Marteau; T Vaysse; A Bourrier; S Nancey; D Laharie; M Allez; G Savoye; C Gilletta; C Gagniere; L Vuitton; S Viennot; A Aubourg; A-L Pelletier; G Bouguen; V Abitbol; M Fumery; P Claudepierre; Y Bouhnik; A Amiot Journal: Aliment Pharmacol Ther Date: 2017-12-18 Impact factor: 8.171
Authors: Laurent Beaugerie; Nicole Brousse; Anne Marie Bouvier; Jean Frédéric Colombel; Marc Lémann; Jacques Cosnes; Xavier Hébuterne; Antoine Cortot; Yoram Bouhnik; Jean Pierre Gendre; Tabassome Simon; Marc Maynadié; Olivier Hermine; Jean Faivre; Fabrice Carrat Journal: Lancet Date: 2009-11-07 Impact factor: 79.321
Authors: Parambir S Dulai; Siddharth Singh; Xiaoqian Jiang; Farhad Peerani; Neeraj Narula; Khadija Chaudrey; Diana Whitehead; David Hudesman; Dana Lukin; Arun Swaminath; Eugenia Shmidt; Shuang Wang; Brigid S Boland; John T Chang; Sunanda Kane; Corey A Siegel; Edward V Loftus; William J Sandborn; Bruce E Sands; Jean-Frederic Colombel Journal: Am J Gastroenterol Date: 2016-06-14 Impact factor: 12.045
Authors: Brian G Feagan; David Schwartz; Silvio Danese; David T Rubin; Trevor W Lissoos; Jing Xu; Karen Lasch Journal: J Crohns Colitis Date: 2018-04-27 Impact factor: 9.071