Vedolizumab Treatment May Reduce Steroid Burden and Improve Histology in Patients With Eosinophilic Gastroenteritis

Abstract

Eosinophilic gastritis (EG) and eosinophilic gastroenteritis (EGE) are rare diseases characterized by marked eosinophilic infiltration of the gastrointestinal (GI) tract and symptoms which typically reflect the location(s) of GI involvement.1,2 Knowledge of these conditions is limited, and treatments, which are largely based on case series, most frequently involve corticosteroids. As long-term steroid treatment is fraught with complications, novel treatment options are needed. Vedolizumab is a humanized monoclonal antibody to the α4β7 integrin that blocks leukocyte migration into GI mucosa.3 Vedolizumab is approved for treatment of moderate to severe inflammatory bowel disease (IBD), and provides benefit via inhibition of gastrointestinal-homing of T lymphocytes.4 However, there is evidence that increased levels of eosinophils can be associated with IBD and may play a role in IBD pathogenesis, that the α4β7 integrin may play an important role in eosinophil localization in IBD, and that blocking α4β7 may inhibit eosinophil recruitment to intestinal mucosa.5,6 Based on this eosinophil effect, there is a strong rationale that vedolizumab may benefit patients with EG/EGE, but it has not yet been assessed in these conditions. Therefore, this study aimed to assess whether vedolizumab therapy is associated with improved clinical symptoms, endoscopic features, and histologic findings in patients with EG/EGE who failed to respond to prior therapies.