Vedolizumab: toward a personalized therapy paradigm for people with ulcerative colitis

Abstract

Ulcerative colitis (UC) is a chronic relapsing and remitting inflammatory bowel disease, with a characteristic leukocytic infiltration of the mucosa. Immunosuppression including anti-TNF-α therapy is a mainstay of treatment for many; however, systemic immunosuppression is not universally effective and is associated with potential side effects. The gut-tropic integrin α4β7, which is expressed on leukocytes, mediates migration from the circulation to the intestinal mucosa. Vedolizumab is a monoclonal antibody which blocks the egress of leukocytes via α4β7, preventing accumulation in the mucosa, and attenuating inflammation without systemic immunosuppression. Vedolizumab has been evaluated in UC in a phase III trial, demonstrating efficacy as both an induction and a maintenance agent. In this article, we review the clinical trial data and also explore the growing body of “real-world” effectiveness data, investigating response and remission rates of vedolizumab in clinical practice. In addition, we review the increasing volume of data supporting the reassuring safety profile associated with vedolizumab.

Keywords:

• vedolizumab
• ulcerative colitis
• personalized therapy

Disclosure

Mark A Samaan has received advisory board fees from Hospira and lecture fees from Hospira, Takeda, and MSD. Nick Powell has received advisory board fees from Abbvie, Allergan, Debiopharm International, Ferring, and Vifor Pharma and lecture fees from Allergan and Falk Pharma. Peter M Irving has received lecture fees from Abbvie, Warner Chilcott, Ferring, Falk Pharma, Takeda, MSD, Janssen, Shire, and Tillotts; financial support for research from MSD and Takeda and Janssen; and advisory board fees from Abbvie, Warner Chilcott, Takeda, MSD, Vifor Pharma, Pharmacosmos, Topivert, Genentech, Hospira, Samsung Bioepis, Janssen, and VH2. Robin J Dart reports no conflicts of interest in this work.