Clinical effect of vedolizumab on articular manifestations spondyloarthritis associated with IBD

This study was performed as a single-centre, retrospective, and observational study, conducted between July 2014 and July 2017. It involved reviewing the charts of all patients with IBD who had undergone treatment with vedolizumab for more than 3 months. A total of 171 patients diagnosed with IBD were treated with vedolizumab. It needs to be noted that 97.1% of patients had been previously treated with at least one TNFi.

All patients included in this study completed the induction phase at last observation; the mean follow-up of the entire cohort was 14.3 months. Of the patient population, 8.2% (14 patients) had a history of IBD-associated SpA (according to ASAS criteria) at the time of initiation of vedolizumab. 5.8% (10 patients) were in clinical remission regarding SpA, while 2.4% (4 patients) had active SpA when they initiated vedolizumab. First, no clinical benefit on SpA following initiation of vedolizumab was found in those 4 patients with active SpA. Second, exacerbation of SpA in patients with clinical remission at initiation of vedolizumab was found in 6/10 patients whereas no effect was reported in the remaining 4/10 patients. All 14 patients with IBD-associated SpA were under TNFi just before starting vedolizumab. Finally, new onset of SpA induced by vedolizumab was reported in 1 patient (see Table).[1]

Table: Characteristics of patients and the main results [1]



Dr. Paccou (Amiens University Medical Center, France) concluded that this study of vedolizumab does not support its efficacy in patients with IBD-associated SpA. It might even induce exacerbation or new onset of SpA. However, inception cohort studies are needed to prospectively evaluate the effect of vedolizumab on joint manifestations.[1] Overall, this study provides good translational therapeutic data supporting the concept that the pathomechanisms of joint manifestations in SpA and IBD differ, at least in a proportion of subjects.