Vedolizumab for inflammatory bowel disease: Changing the game, or more of the same?

Two decades ago, the first reports of the use of monoclonal antibodies targeting tumour-necrosis factor a heralded a revolution in treatment options for moderate to severe Crohn's disease and ulcerative colitis. Nonetheless, patients with refractory disease or loss of treatment response are all too familiar to gastroenterologists. Preventing the infiltration of the gastrointestinal mucosa by circulating cells of the immune system using antibodies targeting the adhesion molecules involved represents an attractive new treatment option. Vedolizumab has recently received European and US regulatory approval for treatment of ulcerative colitis and Crohn's disease on the basis of encouraging results from one of the largest phase III trial programmes ever conducted in the field of inflammatory bowel diseases and promising safety data. Are we now seeing another revolution in the management of inflammatory bowel disease, and how can this new drug best be used in clinical practice?