Prevalence and Real-World Management of Vedolizumab Associated Enthesitis in Successfully Treated IBD Patients
Mirko Di Ruscio, MD,
Ilaria Tinazzi, MD. PhD,
Angela Variola, MD,
Andrea Geccherle, MD,
Antonio Marchetta, MD,
Dennis McGonagle, FRCPI PhD
Rheumatology, keab135,
https://doi.org/10.1093/rheumatology/keab135
Published:
12 February 2021
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Abstract
Background
Studies have reported the development of moderate and severe
de novo spondyloarthritis (SpA) associated disease under vedolizumab (VDZ) treatment for inflammatory bowel disease (IBD). Herein, we report a case series that developed severe enthesitis under VDZ therapy from a cohort of 90 treated cases.
Methods
In a single Italian IBD Unit, where 90 cases were on VDZ therapy, we identified 11 cases that developed severe enthesitis. The onset of disease in relationship to VDZ initiation, clinical and sonographic imaging features, outcomes including therapy switches were described.
Results
11 cases, including 8 prior anti-TNF failures, with new onset entheseal pathology were identified (Multifocal (
n = 4), unifocal (
n = 6), enthesitis/synovitis/dactylitis (
n = 1). The mean duration to symptoms was 46 weeks (range 6–119), mean CRP was 5.1 mg/dl and the majority were HLA-B27 negative and showed good clinical response for gut disease. Clinical features and Ultrasound showed severe enthesitis including PD change in 7 patients.
All patients were initially treated with NSAIDs, 5 patients underwent local steroid injections. At 12 months 5/7 cases continued VDZ and 2 were switched to Ustekinumab. At 12 months follow-up of 7 cases, 5 patients were in clinical remission and 2 patients had mild enthesitis with minimal increase of PD signal. Also 4/7 severe patients developed marked post-inflammatory entheseal calcifications
Conclusions
A predominant isolated severe enthesitis pattern of SpA may develop under VDZ therapy with severe disease in 8% of cases. Most cases continued VDZ therapy
