Crohn’s & Colitis Congress™

Sessions Speakers Exhibitors Floor Plan Buzz

P203 - VEDOLIZUMAB IS SAFE AFTER ANTI-TNF-ASSOCIATED PULMONARY TUBERCULOSIS IN CROHN'S DISEASE: CASE REPORT (Room Poster Hall)

Anti-TNFα agents increase risk of infections due to systemic immunosuppression. Vedolizumab (VDZ) inhibits adhesions of gut-specific lymphocytes and thus may carry a lower risk. However, its safety in patients with prior tuberculosis (TB) infection is not known. We report a patient who developed TB while on anti-TNFα and was later safely maintained on VDZ.  A 55-year-old Bosnian female with prior BCG vaccination was diagnosed with ileocolonic Crohn’s disease (CD) in 2008. It was poorly controlled despite infliximab & later adalimumab treatment. She developed Azathioprine-related pancreatitis and remained on prednisone from diagnosis until ileocecectomy in 2012. Shortly thereafter, she developed a cavitary lung lesion due to tuberculosis (TB). Anti-TNF α was discontinued. She completed 6 months of TB therapy. She remained in remission off IBD specific therapies for 18 months. However, she then developed recurrent abscesses and enteroenteric/enterocutaneous fistulas with intermittent courses of prednisone therapy. She underwent enterocutaneous fistula takedown, ileocolic anastomosis resection & diverting loop ileostomy. VDZ and oral methotrexate were started 3 months later with symptom resolution and inflammatory marker normalization. Colonoscopy/ileoscopy 12 months later confirmed mucosal and histological healing. Surveillance with low-dose CT for lung cancer (continued tobacco use) and TB screening a year later was non-revealing. She remains asymptomatic from a Crohn’s and TB perspective at 15 months. TB infection/reactivation is a known complication of anti-TNFα therapy. In post marketing analysis, in 66,390 patient-years of VDZ therapy, 5 patients developed TB, 2 of whom received anti-TNFα previously. Our patient is unique in that she developed active pulmonary TB after anti-TNFα therapy despite being BCG-vaccinated. She was actively followed for TB reactivation while on VDZ and responded to VDZ therapy without symptoms of TB or Crohns after 12 month follow up.