The majority of people who have primary sclerosing cholangitis (PSC) also have inflammatory bowel disease (IBD). MAdCAM-1, a target of lymphocyte homing integrins, is expressed in the liver and colon. Vedolizumab (VDZ) is a 47 integrin antibody used to treat inflammatory bowel disease (IBD). Researchers looked at the liver outcomes of children with PSC-IBD who were given VDZ. For up to one year of VDZ treatment, demographic, phenotypic, biochemical, radiological, histopathologic, and IBD data were gathered retrospectively. A 75 percent or higher drop in initial -glutamyltransferase (GGT) or a GGT that fell to 50 IU/L and better Mayo endoscopy grade or IBD activity scores after 9 to 12 months were considered positive liver biochemical and IBD responses. Thirty-seven patients were recognized from 19 different facilities. VDZ was started at a median age of 16 years, with 69 percent of patients being male, 65 percent having major duct involvement, 19 percent having fibrosis, and 59 percent having ulcerative colitis. After 9 to 12 months, 22 percent of 32 patients with abnormal GGT at baseline showed a liver biochemical response. In the case of IBD, 32% reached remission, 30% had a clinical response, and 38% had no response. After 9 to 12 months, the final GGT in IBD patients in remission was 51, compared to 127 in those with active IBD.
Liver biochemistry deteriorated over time in IBD patients who were not responding to VDZ but remained stable in IBD patients in remission. VDZ had no effect on liver biochemistry in children with PSC-IBD. Patients with medically resistant IBD may be more prone to progressive liver damage.
