Vedolizumab and the gut-CNS axis in multiple sclerosis: considering T cell licensing pathways.

ABSTRACT:

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.

SUBMITTER: Shirani A 

PROVIDER: S-EPMC12923930 | biostudies-literature | 2026

REPOSITORIES: biostudies-literature