Vedolizumab and etrolizumab for ulcerative colitis: twins or simple cousins?

ABSTRACT

Introduction: Vedolizumab is a monoclonal antibody that selectively blocks α4β7 integrin and has already been approved for use in patients with moderate-to-severe ulcerative colitis both as first and second line. Etrolizumab is a monoclonal antibody still being tested, which acts with a dual mechanism by selectively inhibiting both α4β7 and αEβ7 integrins.

Areas covered: This review provides an overview of the literature data of vedolizumab and etrolizumab, in order to define their role in the treatment of patients with moderate-to-severe ulcerative colitis.

Expert opinion: Etrolizumab and vedolizumab block the α4β7 integrin with a similar action mechanism. However, the inhibition of αEβ7 integrin by etrolizumab distinguishes the two anti-integrins making them ‘cousin’ drugs. Phase 3 clinical trials are needed to confirm the promising etrolizumab’s efficacy data and to resolve any doubts about its safety, allowing a clearer comparison with vedolizumab.

KEYWORDS:

• Vedolizumab
• etrolizumab
• selectivity
• ulcerative colitis

Article highlights

This box summarizes key points contained in the article.

• Vedolizumab is a humanized monoclonal IgG1 antibody that selectively blocks α4β7 integrin.

• Etrolizumab is a humanized monoclonal IgG1 antibody that inhibits the α4β7 and αEβ7 integrins.

• Vedolizumab is an effective and safe drug as evidenced by phase 3 clinical trials and real-life studies.

• A phase 2 study showed that etrolizumab was effective in patients with UC and was associated with an acceptable safety profile.

• The potential advantages of etrolizumab are the dual mechanism of action and the presence of a likely predictor of response to therapy.

• αEβ7 integrin has been detected in extraintestinal organs affecting etrolizumab selectivity.

Declaration of interest

L Peyrin-Biroulet reports personal fees from AbbVie, Allergan, Alma, Amgen, Arena, Biogen, Boerhinger Ingelheim, Celgene, Celltrion, Enterome, Ferring, Genentech, Gilead, Hikma, Index Pharmaceuticals, Janssen, MSD, Nestle, Pfizer, Pharmacosmos, Roche, Samsung Bioepis, Sandoz, Sterna, Takeda and Tillots. S Danese has served as a speaker, consultant, and advisory board member for Schering-Plough, AbbVie, Actelion, Alphawasserman, AstraZeneca, Cellerix, Cosmo Pharmaceuticals, Ferring, Genentech, Grunenthal, Johnson & Johnson, Millenium Takeda, MSD, Nikkiso Europe GmbH, Novo Nordisk, Nycomed, Pfizer, Pharmacosmos, UCB Pharma and Vifor. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper is not funded.