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Emergence of severe spondyloarthropathy-related entheseal pathology following successful vedolizumab therapy for inflammatory bowel disease

Maya142

Moderator
Staff member
Found this pretty disturbing - my daughter's SpA really flared after she was put on Entyvio. We didn't have enough evidence to say it was from the Entyvio at that time, but we did suspect it.


Abstract
Objectives
Vedolizumab (VDZ) blocks α4β7 integrin and is licenced for the treatment of IBD. It has been associated with mild SpA-related features, including sacroiliitis and synovitis. Herein we report a series of cases demonstrating the emergence of severe SpA-associated enthesitis/osteitis following successful IBD therapy with VDZ.

Methods
We evaluated 11 VDZ-treated patients with IBD across seven centres who developed severe active SpA and/or enthesopathy, with the aim of characterizing the VDZ-associated SpA or entheseal flares. Imaging features demonstrating particularly severe disease were recorded.

Results
De novo SpA developed in 9 of 11 patients and flare of known SpA in 2 patients, with 4 patients requiring hospitalization due to disease severity. Available data showed that one of seven cases were HLA-B27 positive. The median time from VDZ initiation to flare was 12 weeks, with IBD well controlled in 7 of 10 patients (no data for 1 patient) at flare. Severe SpA enthesitis/osteitis was evident on MRI or US, including acute sacroiliitis (n = 5), extensive vertebral osteitis (n = 1), peri-facetal oedema (n = 1) and isolated peripheral enthesitis (n = 3). Due to arthritis severity, VDZ was discontinued in 9 of 11 patients and a change in therapy, including alternative anti-TNF, was initiated.

Conclusion
Severe SpA, predominantly HLA-B27 negative, with osteitis/enthesitis may occur under successful VDZ treatment for IBD, including in subjects with prior anti-TNF therapy for intestinal disease.
 

my little penguin

Moderator
Staff member
I had seen other individual case studies which suggested this was happening

Weird that pure GI directed biologics cause joint related arthritis to get worse

And
Pure Joint targeted biologics are trending to cause GI related issues to get worse or develop
 

Maya142

Moderator
Staff member
It's bizarre - IL-17 inhibitors (which, as you said, are used a lot for spondyloarthritis) were actually expected to make IBD better but instead made it worse - I think the trial done for IBD patients was even cut short!!!

But IL-17 is one of the cytokines said to lead to inflammation in IBD, yet it somehow makes it worse.

Similarly, IL-23 plays a role in Ankylosing Spondylitis and so blocking it should have reduced inflammation in AS. However, both Stelara and other IL-23 inhibitors which are in trials and are working well for Psoriatic Arthritis, Psoriasis and IBD, are not effective for AS.

I think my take away from all of this is that scientists don't know nearly enough about the immune system!
 
I think my take away from all of this is that scientists don't know nearly enough about the immune system!
This reminds me of how Remicade can be used to treat psoriasis, and yet there's also Remicade-induced psoriasis.
 
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