Elsevier

Digestive and Liver Disease

Volume 48, Issue 11, November 2016, Pages 1391-1393
Digestive and Liver Disease

Short Report
Vedolizumab is an effective alternative in inflammatory bowel disease patients with anti-TNF-alpha therapy-induced dermatological side effects

https://doi.org/10.1016/j.dld.2016.08.122Get rights and content

Abstract

Background

The treatment of patients with inflammatory bowel diseases has been revolutionized by the introduction of biological therapy with TNF-alpha blockers. However, TNF-alpha blockers are also associated with a wide variety of dermatological side effects, such as local skin infections, psoriasis and eczema. A new biological therapy, targeting the gut-specific adhesion molecule alpha4beta7 integrin, is the humanized monoclonal IgG1 antibody vedolizumab. Vedolizumab prevents leukocyte migration to the gastrointestinal tract, thereby reducing inflammation. This gut-specific therapy has the potential to reduce systemic side effects, including dermatological ones.

Methods

We describe 3 inflammatory bowel disease patients who experience anti-TNF-alpha therapy-induced dermatological side effects, consisting of hidradenitis suppurativa, a folliculitis, scalp psoriasis and a dissecting folliculitis.

Results

In all patients, anti-TNF-alpha therapy-induced dermatological side effects diminished after switching to vedolizumab.

Conclusion

Vedolizumab may be a viable alternative biological therapy in inflammatory bowel disease patients who experience anti-TNF-alpha therapy-induced dermatological side effects.

Introduction

The treatment of patients with Crohn’s disease (CD) and ulcerative colitis (UC) has been revolutionized by the development of biological therapies, such as TNF-alpha blockers. Although TNF-alpha blockers have proven to be effective and relatively safe as treatment for inflammatory bowel disease (IBD) patients, they are also associated with dermatological side effects [1], [2]. These side effects, including local skin infections, psoriasis and eczema are common and often difficult to differentiate from IBD associated extra-intestinal manifestations, such as pyoderma gangrenosum and erythema nodosum [2]. In some cases, starting topical therapy or switching from one TNF-alpha blocker to another is sufficient to reduce dermatological side effects. However, some side effects are a class-specific effect of anti-TNF-alpha therapy with no improvement after switching to another TNF-alpha blocker [2]. A new biological therapy, targeting the gut-specific alpha4beta7 integrin, is the humanized monoclonal IgG1 antibody vedolizumab (VDZ). VDZ prevents leukocyte migration to the gastrointestinal tract, thereby reducing inflammation [3], [4], [5], [6], [7], [8]. It has proved to be effective for inducing and maintaining remission in patients with moderate to severely active CD and UC after failure of conventional treatment or anti-TNF-alpha therapy [3], [4], [5], [6], [7], [8]. Moreover, to date no dermatological side effects have been reported in literature regarding VDZ [2], [3], [4], [5], [6], [7], [8]. From a clinical perspective the question then arises whether the gut-specific VDZ can be used as a viable alternative biological therapy for IBD patients, who experience anti-TNF-alpha therapy-induced dermatological side effects. This article describes the clinical experiences in 3 IBD patients with dermatological side effects, related to anti-TNF-alpha therapy, who benefitted from switching to VDZ.

Section snippets

Case A

Patient A is a 23-year old smoking female with CD since 4 years, located in the ileum and entire colon. The diagnosis was originally confirmed by colonoscopy, biopsies and MRI enterography. She was previously treated with a mesalazine, thiopurines and steroids. However, due to loss of response to steroids and persisting vomiting during thiopurine use, it was decided to start treatment with adalimumab (ADA). After 1 month of treatment disease activity was greatly reduced, demonstrated by a

Discussion

This article describes the clinical experiences in 3 IBD patients with anti-TNF-alpha therapy-induced dermatological side effects, consisting of hidradenitis suppurativa, a folliculitis, scalp psoriasis and a dissecting folliculitis, which diminished after switching to VDZ. As far as we know, this is the first article that describes the potential role of VDZ as a biological therapy that can be used in IBD patients who experience dermatological side effects related to anti-TNF-alpha therapy. VDZ

Conflict of interest

None declared.

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