An induction or flare of arthritis and/or sacroiliitis by vedolizumab in inflammatory bowel disease: a case series

Abstract

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.

Editorial: vedolizumab as a treatment and cause of extra‐intestinal manifestations of inflammatory bowel disease

“…The paradoxical occurrence of joint symptoms with vedolizumab has been reported previously in case series and is not unique to this drug having been reported with anti-TNF therapies. 5,6 Likewise, cutaneous adverse effects such as psoriaform lesions and eczema are recognised with anti-TNF drugs with a similar rate as seen in this study with vedolizumab. 7 It is not yet clear whether these adverse manifestations relate mostly to the specific actions of both types of drug including the balance of cytokines, or are non-specific and due more to their monoclonal antibody structure and potential for induction of autoantibodies.…”

“…In contrast, quality of life seems to be improved early during interferon-free therapy and improves further following completion of successful treatment. 5,6 Taken cumulatively we can infer that virological clearance plays a key role in improvement of quality of life, but cannot be the only factor, since improvement continues long after the virus has completely cleared from the serum. …”

Clinical benefit of vedolizumab on articular manifestations in patients with active spondyloarthritis associated with inflammatory bowel disease

“…However, the effects of VDZ on extraintestinal manifestations were not reported in these trials, and the ‘real life’ experience is still limited. On these premises, we read with interest the recent work by Varkas et al 4 reporting a series of five patients with IBD who were treated with VDZ and promptly developed new onset or exacerbation of spondyloarthritis (SpA), irrespective of the response to treatment on intestinal symptoms. Although the hypotheses proposed by the authors to explain such events sound reasonable, we would like to report our different preliminary results on the effect of VDZ on IBD-associated SpA.…”

Response to: ‘Clinical benefit of vedolizumab on articular manifestations in patients with active spondyloarthritis associated with inflammatory bowel disease’ by Orlando et al

“…We thank Orlando et al 1 for the critical appraisal of our paper 2. However, we believe that the limited sample size and the lack of sufficient follow-up do not support unmistakable evidence of clinical benefit of vedolizumab in spondyloarthritis (SpA).…”