From the Guidelines
Vedolizumab is a biologic that treats immune-mediated colitis from checkpoint inhibitor therapy, apart from Infliximab.
Treatment Options
- Vedolizumab is given intravenously at a 300-mg dose, typically at weeks 0,2, and 6, with a minority of patients receiving longer-term treatment 1.
- The decision to choose Vedolizumab over Infliximab should be based on other risk factors, such as the underlying malignancy and comorbidities, risk of infection, expected duration of treatment, and other concurrent immune-related adverse events 1.
Key Considerations
- Patients who do not respond to Infliximab should switch treatment class to Vedolizumab or vice versa 1.
- Vedolizumab may interfere with ongoing antitumor responses in the GI mucosa in patients receiving immunotherapy for primary GI malignancies or for tumors with GI metastases 1.
- Alternative medications, such as Ustekinumab, Tofacitinib, and Abatacept, can be considered in life-threatening cases, but each has a substantial risk of interfering in antitumor responses based on their mechanisms of action 1.
From the Research
Biologics for Immune-Mediated Colitis
- Apart from Infliximab, the following biologics are used to treat immune-mediated colitis from checkpoint inhibitor therapy:
- Vedolizumab: a study published in 2018 2 found that vedolizumab can be an appropriate treatment for steroid-refractory immune-mediated colitis, with favorable outcomes and a good safety profile.
- Ustekinumab: a study published in 2023 3 found that ustekinumab is a promising therapy for the treatment of refractory immune-mediated colitis.
Mechanism of Action
- Vedolizumab is an integrin receptor antagonist that specifically targets the gut, reducing inflammation and inducing remission in patients with immune-mediated colitis 2.
- Ustekinumab is an IL-12/23 blocker that has been shown to be effective in treating refractory immune-mediated colitis, with a significant reduction in fecal calprotectin levels and clinical remission rates 3.
Comparison with Infliximab
- A study published in 2022 4 compared the efficacy of infliximab and vedolizumab in biologic-naive ulcerative colitis patients, finding similar rates of clinical response and remission, but higher rates of endoscopic remission and corticosteroid-free remission with infliximab.
- Another study published in 2017 5 discussed the use of biologic therapy in ulcerative colitis, including infliximab, adalimumab, golimumab, and vedolizumab, highlighting the importance of personalized treatment approaches.
Treatment Guidelines
- The diagnosis and management of immune-mediated colitis are crucial to avoid detrimental outcomes, with treatment guidelines recommending the use of biologics such as infliximab, vedolizumab, and ustekinumab in patients with refractory disease 6.