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Simultaneous inhibition of α4/β7 integrin and tumour necrosis factor-α in concomitant spondyloarthritis and inflammatory bowel disease
  1. Nicolas Richard1,2,
  2. Elizabeth M Hazel2,
  3. Nigil Haroon1,
  4. Robert D Inman1
  1. 1Division of Rheumatology, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada
  2. 2McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada
  1. Correspondence to Dr. Nicolas Richard, Division of Rheumatology, University Health Network, Toronto Western Hospital, Toronto, ON M5T 2S8, Canada; nicolas.richard2{at}

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We read with interest the article by Varkas et al1 suggesting a temporal association between the initiation of vedolizumab (VDZ) for inflammatory bowel disease (IBD) and induction or worsening of spondyloarthritis (SpA). This suggests that in patients with IBD, there may be limited efficacy of α4/β7 integrin blockade for management of extraintestinal manifestations, particularly for arthritis and sacroiliitis.2 3 Treatment of SpA in subjects on VDZ for associated IBD is highly challenging for the treating physician. We describe below two patients who were treated with a combination treatment of VDZ and certolizumab pegol …

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