P844 Frequency of Extraintestinal Manifestations in vedolizumab versus anti-TNF Treated Patients with Inflammatory Bowel Diseases
Liava, C.(1)*;Sinakos, E.(1);Dimitroulas, T.(1);Navrozidou, C.(2);Akriviadis, E.(1,2);
(1)Aristotle University of Thessaloniki, Fourth Department of Internal Medicine- Hippokration General Hospital of Thessaloniki, Thessaloniki, Greece;(2)Interbalkan Medical Center of Thessaloniki, Gastroenterology Unit, Thessaloniki, Greece;
Background
Patients with moderate to severe inflammatory bowel diseases (IBD) treated with gut-selective vedolizumab (VDZ) may be more likely to develop de novo extraintestinal manifestations (EIMs) or exacerbate pre-existing EIMs, compared to those treated with systemic anti-tumor necrosis factors (anti-TNF), as has been demonstrated mainly in retrospective studies. We aimed to compare the frequency of EIMs in IBD patients treated with VDZ vs those receiving anti-TNF therapies, based on prospectively-retrospectively collected data from a cohort of IBD patients followed in daily clinical practice.
Methods
300 patients with biopsy-confirmed IBD aged 10–90 years old were included in the study. A comprehensive questionnaire was used to collect data on each site visit from July 2018 until March 2022. Logistic regression analysis and chi-squared test were used to compare the frequency of EIMs between IBD patients treated with VDZ vs anti-TNF.
Results
Of the 300 patients with IBD, 111 received biologic therapy [82 with Crohn’s disease (CD), 28 with ulcerative colitis (UC), and 1 with indeterminate colitis (IC)]. The median age of these IBD patients was 39 years. The majority (80%) were treated with anti-TNF agents (88 received anti-TNF and 23VDZ). CD patients received more frequent anti-TNF therapy (69 of 88 patients treated with anti-TNF, OR 2.95; 95% CI: 1.11-7.81; P<.05); patients with UC received more frequently VDZ [10 of 23 patients treated with VDZ (44%) vs 18 of 88 patients treated with anti-TNF (21%), P<.05]. IBD patients diagnosed with perianal disease had an increased trend of receiving anti-TNF therapy than those without (OR 2.34; 95% CI: 0.87-6.31; P=.094). EIMs were observed in 55% of patients included in the cohort (52% were treated with anti-TNF vs 70% treated with VDZ, P=.144), as summarized in table 1. IBD patients treated with VDZ had a 3-fold increased risk of developing de novo or exacerbating pre-existing peripheral arthropathy, compared to those treated with anti-TNF agents (OR 3.03; 95% CI:1.12–8.21; P<.05).
Conclusion
In this cohort study, IBD patients treated with VDZ had a 3-fold increased risk of developing de novo or exacerbating pre-existing peripheral arthropathy, compared to those treated with anti-TNF agents. This result may be explained by the gut-selective anti-inflammatory effect of VDZ, which appears to limit its clinical effect on EIM prevention.