From the Guidelines
In adult outpatients with severe ulcerative colitis, infliximab is generally preferred over Entyvio (vedolizumab) as first-line biologic therapy due to its more rapid onset of action and higher efficacy in inducing remission, as suggested by the AGA clinical practice guidelines 1.
Key Considerations
- Infliximab has a more rapid onset of action, with significant improvement in symptoms within 2-4 weeks, whereas Entyvio may take 10-14 weeks to demonstrate full efficacy.
- The AGA guidelines suggest using infliximab or vedolizumab over adalimumab for induction of remission in biologic-naive patients with moderate-severe UC, based on a network meta-analysis showing higher efficacy of infliximab and vedolizumab compared to adalimumab 1.
- Infliximab is typically administered at 5-10 mg/kg intravenously at weeks 0,2, and 6 for induction, followed by maintenance dosing every 8 weeks, while Entyvio is dosed at 300 mg IV at weeks 0,2, and 6, then every 8 weeks thereafter.
Safety and Efficacy
- Both infliximab and Entyvio have been shown to be effective in inducing and maintaining remission in patients with moderate-severe UC, with infliximab demonstrating a higher efficacy in some studies 1.
- Entyvio has an excellent safety profile with lower risks of serious infections, malignancy, and demyelinating disease compared to TNF inhibitors like infliximab, making it a suitable alternative for patients with contraindications to infliximab 1.
Patient-Specific Factors
- The choice between infliximab and Entyvio should consider disease severity, comorbidities, and the need for rapid symptom control, as well as patient preferences and values regarding treatment convenience and potential side effects 1.
- For patients with extraintestinal manifestations such as arthritis or uveitis, infliximab may offer better control of these symptoms, while Entyvio may be preferred for patients with a history of serious infections or demyelinating disease 1.
From the Research
Entyvio vs Infliximab in Severe UC
- There is no direct comparison between Entyvio and infliximab in the provided studies, as Entyvio is not mentioned in any of the studies.
- However, the studies provide information on the use of infliximab in severe ulcerative colitis (UC):
- Infliximab is effective in treating severe UC, with a study showing that 76% of patients were discharged without colectomy after receiving infliximab 2.
- An accelerated infliximab induction regimen can reduce the need for early colectomy in patients with acute severe UC 3.
- Infliximab and ciclosporin have similar efficacy in treating acute severe UC, with no significant difference in quality-adjusted survival, colectomy rates, or adverse events 4.
- The studies suggest that infliximab is a viable option for treating severe UC, but the decision to use infliximab or other treatments should be made on a case-by-case basis, considering factors such as disease severity, patient response to previous treatments, and potential side effects 5, 2, 3, 4, 6.