Vedolizumab-Induced De Novo Extraintestinal Manifestations

Liege I Diaz; Tara Keihanian; Ingrid Schwartz; Su Bin Kim; Fernando Calmet; Maria Alejandra Quintero; Maria T Abreu

Vedolizumab-Induced De Novo Extraintestinal Manifestations

Gastroenterol Hepatol (N Y). 2020 Feb;16(2):75-81.

Authors

Liege I Diaz^{1

2

3

4

5

6}, Tara Keihanian^{1

2

3

4

5

6}, Ingrid Schwartz^{1

2

3

4

5

6}, Su Bin Kim^{1

2

3

4

5

6}, Fernando Calmet^{1

2

3

4

5

6}, Maria Alejandra Quintero^{1

2

3

4

5

6}, Maria T Abreu^{1

2

3

4

5

6}

Affiliations

¹ Dr Diaz is an advanced gastroenterology fellow in the Department of Gastrointestinal Oncology at the Moffitt Cancer Center in Tampa, Florida.
² Dr Keihanian is a gastroenterology fellow in the Department of Internal Medicine in the Division of Gastroenterology at the University of Miami Miller School of Medicine in Miami, Florida.
³ Dr Schwartz is an internal medicine resident in the Department of Internal Medicine at the University of Miami Miller School of Medicine.
⁴ Dr Kim is a gastroenterology professor in the Department of Internal Medicine in the Division of Gastroenterology at the Cleveland Clinic in Weston, Florida.
⁵ Dr Calmet is a gastroenterologist in the Department of Internal Medicine in the Division of Gastroenterology at Newton-Wellesley Hospital in Boston, Massachusetts. Ms Quintero is a research program manager at the Crohn's & Colitis Center in Miami, Florida.
⁶ Dr Abreu is director of the Crohn's & Colitis Center and professor of medicine and of microbiology and immunology in the Department of Internal Medicine in the Division of Gastroenterology at the University of Miami Miller School of Medicine.

PMID: 34035705
PMCID: PMC8132677

Abstract

Background: Vedolizumab is an α4β7 integrin antagonist with gut-specific effects on lymphocyte and monocyte trafficking. Although the treatment is beneficial for inflammatory bowel disease (IBD), the effects of vedolizumab on extraintestinal manifestations (EIMs) have not been well described. The gut-specific effects of the medication may have diverse outcomes on EIMs. We hypothesize that EIMs may be unmasked by systemic availability of gut-homing effector cells. Aim: The goal of this study is to describe de novo EIMs of IBD patients who were started on vedolizumab. Methods: A retrospective chart review of 71 patients from January 2011 to October 2017, including clinical and medication history and colonoscopy results, was performed. Results: EIMs occurred in 26.7% of patients who were started on vedolizumab. The most common EIMs were arthralgias, perianal fistula, and pyoderma gangrenosum. There was a trend toward a greater occurrence of EIMs in patients with Crohn's disease compared to ulcerative colitis. Conclusion: Our retrospective study suggests that inhibition of gut-specific effector cells results in activated lymphocytes and/or monocytes that cause inflammation in other tissues. More studies are needed to confirm these observations and to develop biomarkers that predict patients at risk for EIMs and perianal fistulas while on vedolizumab.

Keywords: Vedolizumab; arthralgia; extraintestinal manifestations; inflammatory bowel disease; perianal disease.