title: Vedolizumab for the treatment of moderately to severely active ulcerative colitis.
abstract: Ulcerative colitis is a chronic, idiopathic, inflammatory bowel disease characterized by a relapsing and remitting course. A substantial proportion of patients fail conventional therapies despite therapy with immunosuppressives and tumor necrosis factor antagonists. Accordingly, newer therapeutic agents that target disease-specific inflammation and minimize adverse events are required. Central to the pathogenesis of ulcerative colitis is an aberrant host response to commensal microorganisms with a resultant dysregulation of gut immune homeostasis and lymphocyte trafficking. Recently, a newer biologic, vedolizumab, which blocks lymphocyte trafficking, has been developed for use in moderate to severe ulcerative colitis. The efficacy of this agent has been demonstrated to be similar to that of other currently available biologics, and the selectivity of this agent in blocking lymphocyte migration to the gut has substantially reduced treatment-related adverse events. The drug has now been approved for use in the United States and Europe, and, although the exact positioning of this biologic in clinical practice is yet to be defined, it represents an important new chapter in our armamentarium of treatment options for this population. In this review, we will highlight key considerations to be made by providers when using this agent in clinical practice.
authors.affiliation: Robarts Clinical Trials, Robarts Research Institute, Western University, London, Ontario, Canada; Division of Gastroenterology, University of California San Diego, La Jolla, California.
authors.forename: Parambir S
authors.initials: PS
authors.lastname: Dulai
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Mosli
authors.forename: Reena
authors.initials: R
authors.lastname: Khanna
authors.forename: Barrett G
authors.initials: BG
authors.lastname: Levesque
authors.forename: William J
authors.initials: WJ
authors.lastname: Sandborn
authors.forename: Brian G
authors.initials: BG
authors.lastname: Feagan
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000139:chemically induced; D015815:Cell Adhesion Molecules / Q000378:metabolism; D002465:Cell Movement; D002986:Clinical Trials as Topic; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000276:immunology; D004359:Drug Therapy, Combination; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016023:Integrins / Q000037:antagonists & inhibitors*; D007968:Leukoencephalopathy, Progressive Multifocal / Q000139:chemically induced; D000069442:Natalizumab / Q000627:therapeutic use; D009369:Neoplasms / Q000139:chemically induced; D013601:T-Lymphocytes / Q000187:drug effects / Q000502:physiology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D015815:Cell Adhesion Molecules; D007166:Immunosuppressive Agents; D016023:Integrins; D000069442:Natalizumab; D014409:Tumor Necrosis Factor-alpha; C071777:integrin alpha4beta7; C543529:vedolizumab
keywords: inflammatory bowel disease; mucosal addressin cell adhesion molecule-1; ulcerative colitis; vedolizumab; α4β7