Vedolizumab Treatment in Extra-Intestinal Manifestations in Inflammatory Bowel Disease: A Systematic Review

Abstract

Background and Aims We aimed to summarize existing data on the effectiveness of vedolizumab in extra-intestinal manifestations [EIMs] in inflammatory bowel disease [IBD]. Methods We conducted a systematic literature search in PubMed and the Cochrane Library, up to October 2018. Interventional and non-interventional studies as well as case-series studying vedolizumab and EIMs in adult patients with IBD were considered eligible. Results Three interventional studies [one randomized trial, n = 1032; and two open-label trials, n = 347], five non-interventional studies [n = 1496] and three case-series [n = 17] were included. Vedolizumab did not show any effectiveness in primary sclerosing cholangitis [PSC]. While no effect was seen in pre-existing manifestations regarding arthralgia and arthritis, the occurrence of new rheumatic symptoms was lower among vedolizumab users compared to placebo; occurrence was higher, however, with vedolizumab than with tumour necrosis factor inhibitors. Finally, vedolizumab appears not to be efficacious for the treatment of cutaneous manifestations. Conclusions There is no strong evidence to suggest that vedolizumab may be efficacious for the treatment of pre-existing EIMs [especially PSC, rheumatic and cutaneous manifestations], although it may reduce the occurrence of new EIMs.

Pyoderma gangrenosum in an ulcerative colitis patient during treatment with vedolizumab responded favorably to adsorptive granulocyte and monocyte apheresis

“…Chateau et al reported two factors as paradoxical manifestations and extra-intestinal expression of MAdCAM-1. 11 PG lesions may be treated with systemic corticosteroids and anti-TNF-α agents. Other options reported to be effective for treating PG lesions include corticosteroids, dapsone, minocycline, methotrexate, cyclosporine, mycophenolate mofetil, and intravenous immunoglobulin.…”

Pathogenesis and clinical perspectives of extraintestinal manifestations in inflammatory bowel diseases

“…94 In a systematic review, vedolizumab was suggested to reduce the incidence of new EIMs but also be effective in the treatment of preexisting EIMs (particularly PSC, rheumatic and cutaneous manifestations). 95 Data on other biologicals are limited. Ustekinumab is a fully human IgG1 kappa monoclonal antibody that blocks the IL-12/23 p40 subunit.…”

“…According to these results, vedolizumab has no direct therapeutic effect on cutaneous EIMs and can play a role in EIM management by treating disease activity in EIMs that parallels IBD [ 94 ]. In a systematic review, vedolizumab was suggested to reduce the incidence of new EIMs but also be effective in the treatment of preexisting EIMs (particularly PSC, rheumatic and cutaneous manifestations) [ 95 ].…”

Dual‐targeted therapy with apremilast and vedolizumab in pyoderma gangrenosum associated with Crohn’s disease

“…the published work, vedolizumab does not improve pre-existing extraintestinal manifestations of IBD. 3 Indeed, although his gastrointestinal symptoms improved significantly, the patient was still not able to decrease the prednisone to less than 25 mg/day due to persistently active PG. When the patient was first referred for dermatological consultation, he had several painful ulcers on both lower and upper limbs, axillary area, chest, back and face; the clinicopathological features of these lesions confirmed the diagnosis of PG, as reported by Su et al, 4 including the two major criteria and more than two minor ones ( Fig.…”