SAT0324 ARTICULAR MANIFESTATIONS IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE TREATED WITH VEDOLIZUMAB
Authors: Anastasia Dupré, Michael Collins, Franck Carbonnel, Xavier Mariette, Gaetane Nocturne, Raphaèle Seror
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Vedolizumab (VDZ) is a humanized IgG1 monoclonal antibody anti-α4β7 integrin agent used in inflammatory bowel disease (IBD). It has been incriminated in occurrence of articular manifestations but, as it is given in most cases after anti-TNFα therapy, it is not known if these articular manifestations are linked to IBD-associated arthritis and unmasked by withdrawal of anti-TNFα or are more directly linked to VDZ. <h3>Objectives:</h3> The purpose of this study is to describe articular manifestations occurring in patients treated by vedolizumab, and to highlight risk factors for inflammatory manifestations. <h3>Methods:</h3> In this retrospective monocentric study, we collected all the cases of incident articular manifestations occurring in the follow-up of the patients treated by VDZ for IBD. <h3>Results:</h3> Between February 2013 and June 2017, 112 patients were treated withvedolizumab (56 women, age 39.9 ± 16 years, disease duration = 9.1 ± 7.8 years). IBD cases were distributed into59 (52.7%) Ulcerative Colitis (UC), 49 (43.8%) Crohn's disease (CD), and 4 (3.6%) Undetermined Colitis. Fourpatients (3.6%) had a history of spondyloarthritis and 13 (11.6%) of peripheral arthralgia associated with IBD. 102 (91.1%) patients previously received anti-TNFα. At initiation of vedolizumab, 55 (49.1%) received an associated DMARD (azathioprine in 19.6%, purinethol in 11.6%, methotrexate in 7.1%). After a mean follow up duration of 11.4 ± 8.6 months, 32 (28.6%) patients presented 35 types of articular manifestations, mechanical (n = 18) (mostly osteoarthritis and tendinitis)or inflammatory (n = 17). Inflammatory articular manifestations were: early reversible arthralgia mostly occurring during perfusion (n = 5), manifestations linked to IBD (n = 11, axial spondyloarthritis, n = 3, peripheral spondyloarthritis, n = 3, peripheral and axial spondyloarthritis, n = 1, peripheral inflammatory arthralgia, n = 4) with parallel evolution to intestinal symptoms (n = 8) or with independent evolution (n = 3). One patient had chondrocalcinosis (n = 1) (cf figure). Among the 11 patients with articular manifestations linked to IBD, 10 were previously treated with anti-TNFα. The only predictive factor for inflammatory manifestation was a history of previous inflammatory articular manifestation, present in43.8% (n = 7/16) of patients with inflammatory articular manifestation versus in 12.5% (n = 10/80) of patients without articular manifestation, p = 0.007. Vedolizumab was stopped in 7 patients (6.3%), due to articular symptoms (n = 1), to digestive symptoms (n = 4) or both (n = 2). <h3>Conclusion:</h3> Articular manifestations occurred in almost 30% of patients treated with vedolizumab. Half of them were inflammatory (15%), including 5% of early reversible arthralgia during perfusion. We observed 11 manifestations linked to IBD, including 7 spondyloarthritis, potentially unmasked by withdrawal of anti-TNFα. Indeed, the only predictive factor of inflammatory arthritis was history of previous articular inflammatory manifestation. However, awithdrawal of vedolizumab because of inflammatory arthritis was necessary in only 0.9% of all patients. <h3>Disclosure of Interests:</h3> Anastasia Dupré: None declared, Michael Collins Speakers bureau: Lecture fee for Takeda, Abbvie, MSD et Celgene, Franck Carbonnel: None declared, Xavier Mariette Grant/research support from: Servier, Consultant for: AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Janssen, Pfizer, UCB Pharma, Gaetane Nocturne: None declared, Raphaèle Seror: None declared