Are there situations where Vedolizumab (Entyvio) must be used over other biologic therapies in ulcerative colitis or Crohn's disease?

From the Guidelines

There are no absolute situations where Entyvio (vedolizumab) must be used over other biologics for ulcerative colitis or Crohn's disease, but it may be preferred in certain clinical scenarios, such as when patients have failed other therapies, have contraindications to TNF inhibitors, or have specific comorbidities, as suggested by the AGA clinical practice guidelines 1. Entyvio is often considered when patients have a history of malignancy, multiple sclerosis, or other demyelinating disorders, as its gut-selective mechanism of action (targeting α4β7 integrin) limits systemic immunosuppression 1. It's also preferred in elderly patients or those with recurrent infections due to its favorable safety profile. The standard dosing is 300 mg intravenously at weeks 0,2, and 6 for induction, followed by maintenance dosing every 8 weeks. For patients with inadequate response, dosing frequency can be increased to every 4 weeks. A subcutaneous formulation (108 mg) is also available for maintenance therapy after intravenous induction. Entyvio's gut-selective action blocks lymphocyte trafficking specifically to intestinal tissue, which explains its targeted efficacy and reduced risk of systemic adverse effects compared to other biologics that cause broader immunosuppression. Some key points to consider when choosing Entyvio over other biologics include:

• Its efficacy in patients with moderate to severe ulcerative colitis, as demonstrated in the GEMINI I clinical trial 1
• Its safety profile, which is favorable compared to other biologics, especially in patients with a history of malignancy or demyelinating disorders 1
• Its potential as a first-line biologic option for UC failing conventional therapy, as supported by the VARSITY trial 1
• The importance of considering individual patient factors, such as comorbidities and risk of infection, when deciding between Entyvio and other biologics 1.

From the Research

Situations for Entyvio (Natalizumab) Use

• Entyvio is not specifically mentioned as a required treatment in certain situations for ulcerative colitis or Crohn's disease in the provided studies 2, 3, 4, 5, 6.
• However, natalizumab, another anti-α4 integrin, is mentioned as an effective treatment for moderately to severely active CD and UC patients, although it is associated with a higher risk of adverse events, including progressive multifocal leukoencephalopathy 2, 3, 6.

Comparison with Other Biologic Therapies

• Vedolizumab, an anti-α4β7 integrin, is found to have a favorable efficacy and safety profile in bio-naïve patients with UC and CD, with a lower risk of serious adverse events compared to natalizumab 4, 6.
• Anti-TNF drugs, such as adalimumab, certolizumab, and golimumab, are also effective in inducing remission and maintaining response in CD and UC patients, with a similar rate of adverse events to placebo 2, 3.
• The choice of biologic therapy may depend on the individual patient's response to treatment, medical history, and the presence of certain comorbidities 2, 3, 4, 5, 6.

Specific Patient Populations

• Bio-naïve patients with UC and CD may benefit from vedolizumab as a first-line biologic therapy, with a higher probability of clinical remission and a lower risk of serious adverse events 4.
• Patients with refractory CD or relapsing UC may require treatment with alternative biologic therapies, such as natalizumab or anti-TNF drugs, although the efficacy and safety of these treatments may vary depending on the individual patient's circumstances 2, 3, 5, 6.