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Vedolizumab and the gut-CNS axis in multiple sclerosis: considering T cell licensing pathways
Afsaneh Shirani1,2, Olaf Stuve3
1Department of Neurology, Saint Luke's Marion Bloch Neuroscience Institute, Kansas City, MO, USA.
Background:
The role of gut-mediated T cell licensing in multiple sclerosis (MS) remains incompletely understood.
Objective:
We hypothesized that T cell licensing in the gut contributes to MS pathogenesis and evaluated whether vedolizumab-an anti-α4β7 integrin, gut-selective monoclonal antibody approved for inflammatory bowel disease (IBD)-is associated with MS prevalence.
Design:
Retrospective observational study.
Methods:
Using Epic Cosmos, a large deidentified U.S. electronic health record platform, we identified individuals with Crohn's disease (CD) or ulcerative colitis (UC) and a concomitant MS diagnosis between August 2010 and August 2025.
Results:
Among 1,027,704 CD and 1,294,362 UC patients, 8,098 (0.79%; 95%CI:0.77%-0.81%) and 9,564 (0.74%; 95%CI:0.73%-0.76%) had MS, respectively. In contrast, among vedolizumab-treated patients, only 125 with CD (0.22%; 95%CI:0.18%-0.26%) and 109 with UC (0.17%; 95%CI:0.14%-0.20%) developed MS within five years of treatment.
Conclusion:
While causality cannot be inferred, our findings highlight an opportunity to further explore whether vedolizumab-associated differences in MS prevalence may relate to gut-associated immune processes.
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