S0830 The Impact of Vedolizumab on Pre-Existing Extraintestinal Manifestations of Inflammatory Bowel Disease: A Multicenter Study

INTRODUCTION: There are limited data on how vedolizumab (VDZ) impacts extraintestinal manifestations (EIM) in inflammatory bowel disease (IBD). We aimed to determine the outcomes of pre-existing EIMs after initiation of VDZ. METHODS: A multicenter retrospective study of IBD patients with pre-existing EIMs who received at least 1 dose of VDZ between January 1, 2014 and August 1, 2019 was conducted. EIMs included: peripheral arthritis (PA), uveitis, episcleritis, erythema nodosum (EN), pyoderma gangrenosum (PG), stomatitis, sacroiliitis (SI), and ankylosing spondylitis (AS). The primary outcome was the rate of worsening EIMs after VDZ. We assessed factors associated with worsening EIMs, and compared arthritis EIMs (combined PA, SI and AS) to non-arthritis-EIMs after VDZ. RESULTS: A total of 201 IBD patients with EIMs prior to VDZ (median age 38.4 years (IQR, 29–52.4); 62.2% female; 72.6% Crohn’s disease) were included. VDZ was dosed every 6–8 weeks in 59.7% of patients and 66 (32.8%) received combination therapy with immunomodulator. The most common type of EIM prior to VDZ was PA (68.2%), followed by EN/PG (18.9%), SI (15.4%); AS (14.4%); stomatitis (13.9%); and episcleritis/uveitis (12.9%). Worsening of EIMs after VDZ occurred in 34.8% (Table 1). Exacerbations of EIMs occurred more frequently after 3 months of VDZ initiation (58.6%). Patients with worsening of EIM after VDZ were more commonly dosed every 6–8 weeks vs. every 4 weeks (70% vs 45.8%, P = 0.03). There was no significant difference between those with worsened EIM (n = 70) and stable EIM (n = 131) in terms of age, IBD type, concomitant immunosuppressive therapy or IBD disease activity parameters (Table 1). PA was significantly more common in the worsening EIM group (84.3% vs 59.6%, P = 0.0004). Among the 157 patients with arthritis-EIMs combined, 64 (40.8%) demonstrated worsening after VDZ, which was significantly higher compared to 6 (13.6%) among the 44 with non-arthritis-EIM (Figure 1). Worsening of EIM was associated with higher rate of discontinuation of VDZ during study follow-up when compared to the stable EIM group (61.4% vs. 44%, P = 0.02). VDZ was discontinued specifically due to worsening EIM in 9.5%. CONCLUSION: EIM worsening rate after VDZ was 34.8%, more commonly due to arthritis (40.8%) vs. non-arthritis (13.6%) EIMs. Concomitant immunosuppressive therapy, corticosteroids or IBD disease activity did not predict the course of EIMs after VDZ. VDZ had to be discontinued in almost 10% due to worsening EIMs.Table 1.: Characteristics of Patients with Worse and Stable EIM after VedolizumabFigure 1.: Arthritis Extra-intestinal manifestations following Vedolizumab Use (n = 201).