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Clinical and epidemiological research
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An induction or flare of arthritis and/or sacroiliitis by vedolizumab in inflammatory bowel disease: a case series
  1. G Varkas1,2,
  2. K Thevissen1,3,
  3. G De Brabanter4,
  4. L Van Praet1,
  5. F Czul-gurdian5,
  6. H Cypers1,2,
  7. J De Kock1,
  8. P Carron1,3,
  9. M De Vos6,
  10. P Hindryckx6,
  11. J Arts7,
  12. I Vanneuville3,
  13. P Schoenaers8,
  14. B Claerhout8,
  15. M Abreu5,
  16. F Van den Bosch1,
  17. D Elewaut1,2
  1. 1Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
  2. 2VIB Inflammation Research Center, Ghent University, Ghent, Belgium
  3. 3Department of Rheumatology/Physical medicine and rehabilitation, AZ Alma, Sijsele-Eeklo, Belgium
  4. 4Department of Rheumatology, AZ Sint-Lucas Brugge, Bruges, Belgium
  5. 5The Crohn's and Colitis Center, Miller School of Medicine, University of Miami, Miami, Florida, USA
  6. 6Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
  7. 7Department of Gastroenterology, AZ Sint-Lucas Brugge, Bruges, Belgium
  8. 8Department of Gastroenterology, AZ Alma, Sijsele-Eeklo, Belgium
  1. Correspondence to Professor Dr D Elewaut, Department of Rheumatology, Ghent University Hospital, De Pintelaan 185, Ghent 9000, Belgium; Dirk.elewaut{at}ugent.be

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.

  • Arthritis
  • Spondyloarthritis
  • Treatment
  • Magnetic Resonance Imaging
  • Inflammation

https://doi.org/10.1136/annrheumdis-2016-210233

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    Footnotes

    • Handling editor Tore K Kvien

    • Contributors GV, MDV, PH, FVdB and DE: study concept and design. GV, KT, GDB, LVP, FC, HC, JDK, PC, MDV, PH, JA, IV, PS, BC, MA, FVdB and DE: data acquisition. GV, PC, FVdB and DE: analysis and interpretation of data. GV, MDV, MA, FVdB and DE: manuscript preparation. GV, KT, GDB, LVP, MDV, PH, MA, FVdB and DE: manuscript revision.

    • Funding This study was supported by a grant of Ghent University to GV. DE is supported by a fund of Scientific Research–Flanders (FWO) and the Research Council of Ghent University. DE is also a member of a multidisciplinary research platform (MRP) of Ghent University and is supported by Interuniversity Attraction Pole (IUAP) grant Devrepair from the Belspo Agency (project P7/07).

    • Competing interests DE has received grants or speakers fees from Boehringer Ingelheim, Pfizer, UCB, Merck, Novartis, Janssen and Abbvie. FVdB received consultancy and/or speaker fees from Abbvie, Celgene, Janssen, Merck, Novartis, Pfizer and UCB.

    • Patient consent Obtained.

    • Ethics approval The study protocol was approved by the Ethical Committee of Ghent University Hospital.

    • Provenance and peer review Not commissioned; externally peer reviewed.