Response to: 'Clinical benefit of vedolizumab on articular manifestations in patients with active spondyloarthritis associated with inflammatory bowel disease by Orlando et al

We thank Orlando et al1 for the critical appraisal of our paper.2 However, we believe that the limited sample size and the lack of sufficient follow-up do not support unmistakable evidence of clinical benefit of vedolizumab in spondyloarthritis (SpA). First of all, merely 36 out of 53 patients with inflammatory bowel disease (IBD) completed the 6-week induction phase at the last recorded observation, which makes the interpretation of data premature. Hence, as stated in our paper, mean time to flare in our patients was calculated at 64 days after the initiation of vedolizumab, ranging up to 114 days in these selected cases. The patients presented in the series from Orlando et al are also much older (mean 51.5 years vs 36.0 years) and display a higher rate of surgical intervention (>60%) compared with our cases, which may respectively reflect a population less likely to develop SpA features and a...