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Association Between Vedolizumab Therapy and Peripheral Eosinophilia in Pediatric and Young Adult Inflammatory Bowel Disease
Abstract   Open access   Peer reviewed

Association Between Vedolizumab Therapy and Peripheral Eosinophilia in Pediatric and Young Adult Inflammatory Bowel Disease

Karl McNamara, Benjamin Davis and Dawn Ebach
Journal of allergy and clinical immunology, Vol.157(2 Supplement), p.AB92
02/2026
DOI: 10.1016/j.jaci.2025.12.272
url
https://doi.org/10.1016/j.jaci.2025.12.272View
Published (Version of record) Open Access

Abstract

Rationale Vedolizumab is a gut-selective α4β7 integrin antagonist used for Inflammatory Bowel Disease (IBD) which blocks eosinophil migration into the gut. Its effect on peripheral eosinophil counts is not well-established, with isolated case reports suggesting a link between vedolizumab and peripheral eosinophilia. We aimed to investigate this association in a pediatric and young adult IBD cohort. Methods This single-center retrospective chart review included 23 IBD patients (ages 8-28) treated with vedolizumab for ≥1 year who had sufficient absolute eosinophil count (AEC) data on and off therapy. For each patient, we compared the average AEC from all time points during active therapy to the average AEC off therapy. The off-therapy period included all baseline measurements before treatment and any measurements taken 4 months after vedolizumab cessation (5 half-lives). Due to a non-normal data distribution, a Wilcoxon signed-rank test was used for statistical analysis. Results Average AEC was significantly higher on vedolizumab versus off (median 265 cells/mL [IQR: 151.8–505.0] vs. 200 cells/mL [IQR: 112.2–446.5], mean 429 vs. 293 cells/mL; p=0.025). The majority of patients (14/22, 64%) developed peripheral eosinophilia (>500 cells/mL) while on vedolizumab despite frequent corticosteroid use (prednisone, methylprednisolone, hydrocortisone, or budesonide) in both treatment and non-treatment periods. Conclusions In this young IBD cohort, vedolizumab therapy was associated with a statistically significant increase in peripheral eosinophil counts. This finding contrasts with vedolizumab's gut-selective mechanism and may indicate complex interactions of eosinophil trafficking/homeostasis. This finding of a potential systemic effect suggests that monitoring peripheral eosinophils should be considered in this population to inform therapeutic decision making.

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