Introducing Vedolizumab to Clinical Practice: Who, When, and How?

Vedolizumab (VDZ), a humanized monoclonal antibody that selectively targets a4 beta 7 integrin, is approved for use in inflammatory bowel disease (IBD). Here we review the evidence for the safety and efficacy of VDZ in IBD, in order to identify patients likely to benefit from therapy and to integrate VDZ into clinical practice. A bibliographic search was performed of the online databases MEDLINE, EMBASE, PubMed, and the Cochrane Library, using the key words 'inflammatory bowel diseases' OR 'ulcerative colitis' OR 'Crohn's disease' AND 'vedolizumab' OR 'MLN0002' OR 'integrin alpha4beta7' OR 'anti-integrin'. Eight-nine articles were returned using the primary search. Eight randomized controlled trials, one Cochrane review, and two network meta-analyses were identified. VDZ is well tolerated with a low rate of adverse events (similar to placebo), and is associated with minimal systemic immunosuppression. VDZ is effective for induction and maintenance of remission in outpatients with moderate to severe ulcerative colitis (UC) or Crohn's disease (CD) who have failed conventional and anti-tumor necrosis factor (anti-TNF) therapy. VDZ is also a first-line alternative to anti-TNF therapy in UC. The efficacy of VDZ is best assessed at, or beyond, 10 weeks of therapy. The safety, tolerability, and efficacy profile of VDZ place it as a new therapy in IBD, though further trials directly comparing VDZ with other biological agents as well as pragmatic studies to evaluate cost-effectiveness are necessary.