Link Between Vedolizumab Treatment And Articular Manifestations Unclear

It was unclear whether treatment of inflammatory bowel disease (IBD) with vedolizumab (VDZ) causes articular manifestations in patients, according to results from a retrospective monocentric study published in Rheumatology.

Between 2013 and 2017, researchers retrospectively recruited 112 patients treated for IBD with VDZ at Bicêtre Hospital in Paris, France. They then analyzed patients for musculoskeletal manifestations during the treatment period. The IBD cohort consisted of patients with ulcerative colitis (n=59), Crohn’s disease (n=49), and those with undetermined colitis (n=4). Some patients in the study population had some history of rheumatic disorders, including 4 with spondyloarthritis (SpA) and 13 with peripheral arthralgia. Most patients (91.1%) had previously received anti-tumor necrosis factor α (TNF) therapy.

Nearly a third (28.6%, n=32) of patients presented with 35 new musculoskeletal manifestations after a mean follow-up time of 11.4 months. Of these manifestations, 18 were mechanical and 17 inflammatory. The inflammatory manifestations consisted of 11 instances of axial or peripheral SpA, 5 instances of early reversible arthralgia, and 1 instance of was chondrocalcinosis.

Of the 11 patients with axial or peripheral SpA, 8 had active IBD, and 3 had inactive IBD. In the latter group, SpA could be considered ‘paradoxical SpA’, in which IBD symptoms improved but patients developed SpA nonetheless. In the active IBD group, 4 patients switched to anti-TNF therapy, 2 to Ustekinumab, 1 discontinued treatment, and 1 continued with VDZ.

The only statistically significant association of inflammatory manifestation occurrence reported by the researchers was a prior musculoskeletal manifestation (43.8% previous manifestations vs 12.5% no previous manifestations; P =.007).

One limitation of this study is the retrospective nature. Although the design did allow for recruitment of all patients treated at the hospital, reducing bias, it also prohibited the assessment of HLA B27 status or steroids dosage, which were both possible sources of bias.

The study authors concluded that nearly a third of the patients with IBD treated with VDZ had musculoskeletal manifestations, but that only half of those were inflammatory. Due to the medical history of their patient population, it was impossible to assess whether the inflammatory manifestations were due to VDZ treatment, anti-TNF treatment, or some combination of the 2 drug therapies. The researchers note that further study is required to make a clear distinction between these possibilities.

Disclosures: Some authors declared receiving consulting or funding from the pharmaceutical industry. A complete list of disclosures can be found in the original study.

Reference

Dupré A, Collins M, Nocturne G, et al. Articular manifestations in patients with inflammatory bowel disease treated with vedolizumab. Rheumatology 2020;0:1-9. doi:10.1093/rheumatology/keaa107.