The effect of vedalizumab on the occurence and the clinical course of spondyloarthritis in patients with inflammatory bowel disease

Introduction: Vedolizumab (VDZ) is a novel anti-inflammatory molecule that is currently being used in the treatment of refractory inflammatory bowel disease (IBD). The mode of action is the inhibiting the binding of activated T lymphocytes to the adhesion molecule 1 of intestinal mucosal cells. Due to its local effect, systemic immunosuppresion is not expected and this may have a negative effect on the extra-intestinal symptoms of IBD, particularly spondyloarthritis (SpA). Currently there is limited data regarding the effect of VDZ on SpA symptoms. Objective: We aimed to investigate whether VDZ has an effect on the occurence of rheumatological symptoms and the clinical course of patients who have SpA. Methods: 39 adult IBD patients who were followed up in the Dokuz Eylul University Gastroenterology Clinic and treated with VDZ were included in the study. Patients were reviewed in terms of rheumatological manifestations. The occurence of new musculoskeletal findings during the VDZ treatment were recorded. Patients with a former diagnosis of SpA were evaluated for the activity of axial and peripheral manifestations during the VDZ. Results: There were 39 IBD patients (29 CD, 10 UC, 48,7% [n=19] male [M]) who had been treated with VDZ. The mean age of the patients was 41,4 ±15,7 years, and the duration of IBD was 10,4±7,5 years. A total of 17 (44%) patients had an accompanying SpA findings (mean age 47,08±15,325 years and 58,8% E). Seven patient had an axial dominant symtoms and six of them were in active disease state before VDZ. During VDZ, all but one continued to be active. There were 14 patients with arthritis/arthralgias before VDZ and only three had improvement with therapy. On the other hand, there were 3 patients who had new onset arthralgias/arthritis with VDZ. In total 6 patients needed to stop VDZ because of SpA activation (n=2) and uncontrolled IBD (n=4) respectively. Conclusion: Treatment with VDZ seem no effect on both the occurence and the course of rheumatological manifestations in IBD patients. Further studies are required to replicate our results.