The Impact of Vedolizumab and Ustekinumab on Articular Extra-Intestinal Manifestations in Inflammatory Bowel Disease Patients: A Real-Life Multicentre Cohort Study

Abstract

Background and aims Extra-intestinal manifestations are frequently reported in inflammatory bowel diseases. However, data comparing the effect of vedolizumab and ustekinumab on articular extra-intestinal manifestations are limited. The aim was to evaluate differences in new onset and evolution of pre-existing joint extra-intestinal manifestations during both treatments. Methods An international multicentric retrospective study was performed on inflammatory bowel disease patients who started vedolizumab or ustekinumab between May 2010 and December 2020. Extra-intestinal manifestations were assessed at baseline and joint extraintestinal manifestations were evaluated throughout the 2-year follow-up. Arthropathy was defined by joint inflammation (arthritis/sacroiliitis), diagnosed by a rheumatologist, and arthralgia as articular pain without confirmed inflammation. Additionally, skin, ocular and hepatic extra-intestinal manifestations were assessed at baseline. Uni- and multivariate analyses were performed. Results In total 911 patients (vedolizumab:584; ustekinumab:327) were included. Deterioration of pre-existing arthropathy and rate of new onset arthropathy were not significantly associated with vedolizumab over ustekinumab. Arthropathy was reason to stop treatment in 6 vedolizumab and 2 ustekinumab patients. The odds of developing new arthralgia within 6 months was higher in patients who took vedolizumab compared to ustekinumab (aOR: 2.28 [1.01-5.15], p=0.047). However, this effect was not sustained during the 2-year follow-up (aOR: 1.35 [0.80-2.29], p=0.259). Deterioration of pre-existing arthralgia was comparable between ustekinumab and vedolizumab treated patients. In 2 vedolizumab-treated patients arthralgia was reason to stop treatment. Conclusions Vedolizumab and ustekinumab can be used safely in patients with articular extra-intestinal manifestations. Only a temporary increased risk for developing arthralgia has been observed under vedolizumab.

Iranian Consensus Guideline for Pharmacotherapy with Biologics and Small Molecules Drugs in Adults with Inflammatory Bowel Diseases

“…One study reported worsening EIMs in almost one-third of patients. 85 A temporarily increased risk for developing arthralgia has been reported under vedolizumab in 2-year follow-up 86 Until more data become available, we recommend against vedolizumab in patients with EIM.…”

Beyond the Gut: A Systematic Review and Meta-analysis of Advanced Therapies for Inflammatory Bowel Disease-associated Extraintestinal Manifestations

“…This finding is similar to a recent study comparing new joint EIMs in patients receiving UST and VDZ. 63 …”

“…Studies comparing VDZ and UST directly also observed that patients on VDZ experienced a higher occurrence of deteriorating pre-existing rheumatic EIMs than patients receiving VDZ, although the difference did not reach statistical significance. 63 …”

Latest Treatment Perspectives for IBD-related Arthritis - a review

“…New onset of arthropathy was diagnosed in 11 patients (2%) receiving VDZ, but neither was it identified as risk factor in a multivariate regression model, assessing new onset arthropathy during the 2-year follow-up (aOR: 0.82 IC95%: [0.30-2.29]; p=0.708). The authors conclude, that patients with articular EIMs can be treated safely with VDZ [48]. The large sample size, a long-follow up period, a clear distinction between arthritis and arthralgia and careful consideration of numerous confounders in multivariate regression model contribute to the high quality of the study.…”