The impact of vedolizumab and ustekinumab on articular extra-intestinal manifestations in inflammatory bowel disease patients : a real-life multicentre cohort study

Background and aims: Extra-intestinal manifestations are frequently reported in inflammatory bowel diseases. However, data comparing the effect of vedolizumab and ustekinumab on articular extra-intestinal manifestations are limited. The aim was to evaluate differences in new onset and evolution of pre-existing joint extra-intestinal manifestations during both treatments. Methods: An international multicentric retrospective study was performed on inflammatory bowel disease patients who started vedolizumab or ustekinumab between May 2010 and December 2020. Extra-intestinal manifestations were assessed at baseline and joint extraintestinal manifestations were evaluated throughout the 2-year follow-up. Arthropathy was defined by joint inflammation (arthritis/sacroiliitis), diagnosed by a rheumatologist, and arthralgia as articular pain without confirmed inflammation. Additionally, skin, ocular and hepatic extra-intestinal manifestations were assessed at baseline. Uni- and multivariate analyses were performed. Results: In total 911 patients (vedolizumab:584; ustekinumab:327) were included. Deterioration of pre-existing arthropathy and rate of new onset arthropathy were not significantly associated with vedolizumab over ustekinumab. Arthropathy was reason to stop treatment in 6 vedolizumab and 2 ustekinumab patients. The odds of developing new arthralgia within 6 months was higher in patients who took vedolizumab compared to ustekinumab (aOR: 2.28 [1.01-5.15], p=0.047). However, this effect was not sustained during the 2-year follow-up (aOR: 1.35 [0.80-2.29], p=0.259). Deterioration of pre-existing arthralgia was comparable between ustekinumab and vedolizumab treated patients. In 2 vedolizumab-treated patients arthralgia was reason to stop treatment. Conclusions: Vedolizumab and ustekinumab can be used safely in patients with articular extra-intestinal manifestations. Only a temporary increased risk for developing arthralgia has been observed under vedolizumab. Keywords: biologicals; inflammatory bowel disease; spondyloarthropathy

The impact of vedolizumab and ustekinumab on articular extra-intestinal manifestations in inflammatory bowel disease patients : a real-life multicentric cohort study

Background and aims: Extra-intestinal manifestations are frequently reported in inflammatory bowel diseases. However, data comparing the effect of vedolizumab and ustekinumab on articular extra-intestinal manifestations are limited. The aim was to evaluate differences in new onset and evolution of pre-existing joint extra-intestinal manifestations during both treatments. Methods: An international multicentric retrospective study was performed on inflammatory bowel disease patients who started vedolizumab or ustekinumab between May 2010 and December 2020. Extra-intestinal manifestations were assessed at baseline and joint extraintestinal manifestations were evaluated throughout the 2-year follow-up. Arthropathy was defined by joint inflammation (arthritis/sacroiliitis), diagnosed by a rheumatologist, and arthralgia as articular pain without confirmed inflammation. Additionally, skin, ocular and hepatic extra-intestinal manifestations were assessed at baseline. Uni- and multivariate analyses were performed. Results: In total 911 patients (vedolizumab:584; ustekinumab:327) were included. Deterioration of pre-existing arthropathy and rate of new onset arthropathy were not significantly associated with vedolizumab over ustekinumab. Arthropathy was reason to stop treatment in 6 vedolizumab and 2 ustekinumab patients. The odds of developing new arthralgia within 6 months was higher in patients who took vedolizumab compared to ustekinumab (aOR: 2.28 [1.01-5.15], p=0.047). However, this effect was not sustained during the 2-year follow-up (aOR: 1.35 [0.80-2.29], p=0.259). Deterioration of pre-existing arthralgia was comparable between ustekinumab and vedolizumab treated patients. In 2 vedolizumab-treated patients arthralgia was reason to stop treatment. Conclusions: Vedolizumab and ustekinumab can be used safely in patients with articular extra-intestinal manifestations. Only a temporary increased risk for developing arthralgia has been observed under vedolizumab. Keywords: biologicals; inflammatory bowel disease; spondyloarthropathy

Impact of bread diet on intestinal dysbiosis and irritable bowel syndrome symptoms in quiescent ulcerative colitis: A pilot study.

Gut microbiota may be involved in the presence of irritable bowel syndrome (IBS)-like symptomatology in ulcerative colitis (UC) patients in remission. Bread is an important source of dietary fiber, and a potential prebiotic. To assess the effect of a bread baked using traditional elaboration, in comparison with using modern elaboration procedures, in changing the gut microbiota and relieving IBS-like symptoms in patients with quiescent ulcerative colitis. Thirty-one UC patients in remission with IBS-like symptoms were randomly assigned to a dietary intervention with 200 g/d of either treatment or control bread for 8 weeks. Clinical symptomatology was tested using questionnaires and inflammatory parameters. Changes in fecal microbiota composition were assessed by high-throughput sequencing of the 16S rRNA gene. A decrease in IBS-like symptomatology was observed after both the treatment and control bread interventions as reductions in IBS-Symptom Severity Score values (p-value < 0.001) and presence of abdominal pain (p-value < 0.001). The treatment bread suggestively reduced the Firmicutes/Bacteroidetes ratio (p-value = 0.058). In addition, the Firmicutes/Bacteroidetes ratio seemed to be associated with improving IBS-like symptoms as suggested by a slight decrease in patient without abdominal pain (p-value = 0.059). No statistically significant differential abundances were found at any taxonomic level. The intake of a bread baked using traditional elaboration decreased the Firmicutes/Bacteroidetes ratio, which seemed to be associated with improving IBS-like symptoms in quiescent ulcerative colitis patients. These findings suggest that the traditional bread elaboration has a potential prebiotic effect improving gut health (ClinicalTrials.gov ID number of study: NCT05656391)