Influence of vedolizumab on extraintestinal manifestations in inflammatory bowel disease: a nationwide multicenter study of the GETECCU ENEIDA Registry

BACKGROUND AND AIMS: Evidence regarding the influence of vedolizumab (VDZ) on extraintestinal manifestations (EIMs) of inflammatory bowel disease (IBD) is limited. Our aim was to analyze the effectiveness of VDZ in preexisting EIMs and the occurrence of de novo EIMs during VDZ therapy for IBD. METHODS: This observational, multicenter, retrospective cohort study included patients from the Spanish ENEIDA registry. All EIMs were assessed at baseline, and clinical response and worsening of IBD and EIMs were evaluated at 3 and 12 months after VDZ initiation, according to the physician's assessment. RESULTS: We retrospectively identified 551 patients with IBD treated with VDZ. At baseline, 133 patients (24.1%) had preexisting EIMs, with 77 having active EIMs. At 3 months, 29.9% of these patients showed clinical improvement, 16.9% experienced worsening, and 53.2% remained unchanged. Clinical response of IBD at 3 months was the only factor associated with EIM improvement (OR 3.72; 95% CI 1.08-12.83). Among 56 patients with inactive EIMs at baseline, 13.5% experienced worsening after 12 months. During follow-up, 25 patients (4.5%) developed 27 de novo EIMs. The presence of 2 preexisting EIMs was the only factor associated with de novo EIM onset (OR 16.2; 95% CI 4.3-60.9). Worsening of preexisting EIMs or de novo EIMs led to VDZ discontinuation in 15 patients (5.8% of all patients who discontinued VDZ and 2.7% of the entire cohort). CONCLUSIONS: VDZ achieved clinical response of active EIMs in nearly one-third of patients after 3 months. Although infrequent, VDZ may exacerbate inactive EIMs and induce de novo EIMs during therapy, potentially leading to treatment discontinuation.