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      Effects of Vedolizumab Therapy on Extraintestinal Manifestations in Inflammatory Bowel Disease

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          Abstract

          Background

          Approximately 15–20% of ulcerative colitis patients and 20–40% of those with Crohn’s disease experience extraintestinal manifestations (EIMs) of their inflammatory bowel disease (IBD). Clinicians who treat IBD must manage EIMs affecting multiple organs that variably correlate with intestinal disease activity. Vedolizumab is a monoclonal antibody for the treatment of IBD with a gut-selective mechanism of action.

          Aims

          This report evaluates whether vedolizumab is an effective treatment of EIMs, given its gut-specific mechanism of action.

          Methods

          We report 8 case studies of patients with various EIMs, including pyoderma gangrenosum, peripheral arthralgia/arthritis, axial arthropathies, erythema nodosum, and uveitis, who received vedolizumab therapy.

          Results

          Vedolizumab therapy was effective for pyoderma gangrenosum in ulcerative colitis, uveitis, erythema nodosum, polyarticular arthropathy, and ankylosing spondylitis/sacroiliitis but did not provide sustained benefit for the treatment of pyoderma gangrenosum in a patient with Crohn’s disease.

          Conclusions

          These cases demonstrate the potential of vedolizumab as a treatment of EIMs in patients with IBD.

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          Most cited references29

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          Extraintestinal Manifestations of Inflammatory Bowel Disease

          Article first published online 2 July 2015
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            The First European Evidence-based Consensus on Extra-intestinal Manifestations in Inflammatory Bowel Disease.

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              The prevalence of extraintestinal diseases in inflammatory bowel disease: a population-based study.

              The aim of this study was to determine the prevalence of the major extraintestinal manifestations of inflammatory bowel disease (IBD) and their relation to disease diagnosis and gender. We used the population-based University of Manitoba IBD Database, which includes longitudinal files on all subjects of all health system contacts identified by International Classification of Diseases, 9th Revision, Clinical Modification codes for visit diagnosis. We extracted a cohort from our database, which included subjects with a known diagnosis of IBD for at least 10 yr. We then determined how many contacts each subject had for each of the following extraintestinal IBD-associated immune diseases: primary sclerosing cholangitis, ankylosing spondylitis, iritis/uveitis, pyoderma gangrenosum, and erythema nodosum. We calculated the prevalence of the extraintestinal diseases using an administrative definition of having at least five health system contacts for the diagnosis in question. This administrative definition has previously been validated in Crohn's disease and ulcerative colitis (UC). A total of 6.2% of patients with IBD had one of six major extraintestinal diseases studied in this report. Only 0.3% of patients had multiple extraintestinal diseases. Iritis/uveitis was the most common extraintestinal disease of all assessed (2.2% of women and 1.1% of men). Iritis/uveitis was more common among women, particularly those with UC (3.8%). Primary sclerosing cholangitis was most common among men with UC (3%). Ankylosing spondylitis was more common among men, and the highest rate was seen among men with Crohn's disease (2.7%). Pyoderma gangrenosum was more common in Crohn's (1.2%) with no gender predilection. Erythema nodosum was similarly present in Crohn's and UC but was more common among women (1.9%). The associations of immune mediated diseases in extraintestinal sites may help us to further our understanding of IBD pathogenesis, and it may help us in developing a paradigm of disease subsets.
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                Author and article information

                Contributors
                mfleisher@bgclinic.com
                jan.marsal@med.lu.se
                leesd@uw.edu
                fradol@gmail.com
                aparian1@jhmi.edu
                212-434-2063 , bkorelitzmd@gmail.com
                (226) 270-7675 , Brian.feagan@robartsinc.com
                Journal
                Dig Dis Sci
                Dig. Dis. Sci
                Digestive Diseases and Sciences
                Springer US (New York )
                0163-2116
                1573-2568
                26 February 2018
                26 February 2018
                2018
                : 63
                : 4
                : 825-833
                Affiliations
                [1 ]Borland-Groover Clinic, Jacksonville, FL USA
                [2 ]ISNI 0000 0001 0930 2361, GRID grid.4514.4, Lund University, ; Lund, Sweden
                [3 ]ISNI 0000000122986657, GRID grid.34477.33, University of Washington, ; Seattle, WA USA
                [4 ]GRID grid.416167.3, Mount Sinai Hospital, ; New York, NY USA
                [5 ]ISNI 0000 0001 2192 2723, GRID grid.411935.b, Johns Hopkins Hospital, ; Baltimore, MD USA
                [6 ]ISNI 0000 0001 2215 7314, GRID grid.415895.4, Division of Gastroenterology, Department of Medicine, , Lenox Hill Hospital, ; New York, NY 10075 USA
                [7 ]ISNI 0000 0004 1936 8884, GRID grid.39381.30, Robarts Clinical Trials, Robarts Research Institute, , Western University, ; 100 Dundas Street, Suite 200, London, ON N6A 5B6 Canada
                Article
                4971
                10.1007/s10620-018-4971-1
                5854745
                29484571
                a5b778e8-d693-4d9c-aec5-1e92f8063b1b
                © The Author(s) 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                : 3 October 2017
                : 8 February 2018
                Funding
                Funded by: Takeda Pharmaceuticals U.S.A., Inc.
                Categories
                Review
                Custom metadata
                © Springer Science+Business Media, LLC, part of Springer Nature 2018

                Gastroenterology & Hepatology
                inflammatory bowel disease,crohn’s disease,ulcerative colitis,extraintestinal manifestations

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