vedolizumab
Brand: Entyvio
Prototype Drug
Drug Class: integrin receptor antagonist (gut-selective biologic)
Drug Family: biologic
Subclass: anti-alpha4beta7 integrin monoclonal antibody
Organ Systems: gastrointestinalimmunology
Mechanism of Action
Humanized monoclonal antibody that selectively binds alpha4beta7 integrin expressed on gut-homing T-lymphocytes, blocking interaction with mucosal addressin cell adhesion molecule-1 (MAdCAM-1) in the GI tract. This prevents lymphocyte trafficking into the GI mucosa, reducing mucosal inflammation in a gut-selective manner without systemic immune suppression.
alpha4beta7 integrin (on gut-homing T-lymphocytes)
Indications
- moderate to severely active ulcerative colitis
- moderate to severely active Crohn's disease
Contraindications
- active severe infection
- hypersensitivity to vedolizumab
Adverse Effects
Common
- nasopharyngitis
- headache
- arthralgia
- nausea
- infusion-related reactions
Serious
- serious infections (less common than systemic biologics due to gut selectivity)
- progressive multifocal leukoencephalopathy (PML) — reported, though extremely rare
- hepatotoxicity (rare)
Pharmacokinetics (ADME)
| Absorption | IV infusion; subcutaneous formulation also available |
| Distribution | low Vd; primarily intravascular distribution |
| Metabolism | proteolytic catabolism |
| Excretion | proteolytic degradation |
| Half-life | 25 days |
| Onset | weeks (induction dosing) |
| Peak | end of infusion |
| Duration | weeks (maintenance every 8 weeks) |
| Protein Binding | not applicable (monoclonal antibody) |
| Vd | low |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| live vaccines | immunosuppressive effect may reduce vaccine efficacy and increase infection risk | major |
| natalizumab | both agents target integrin receptors; combined use not recommended | major |
Nursing Considerations
- Administer IV infusion over 30 minutes at 0, 2, and 6 weeks for induction, then every 8 weeks for maintenance.
- Screen for active tuberculosis, viral hepatitis, and other serious infections before initiating; vedolizumab is gut-selective so systemic infection risk is lower than TNF inhibitors.
- Monitor for infusion reactions during and for 1 hour after infusion; have resuscitation equipment available.
- Avoid live vaccines during therapy; ensure patients are up to date on all vaccinations (including killed and live) before starting.
Clinical Pearls
- Vedolizumab's gut-selective mechanism means it does not suppress systemic immunity, giving it a favorable safety profile compared to TNF inhibitors — particularly regarding opportunistic infections.
- Response is typically slower than TNF inhibitors (12–14 weeks for clinical response), making it less ideal for patients in acute severe flare but preferred for those with comorbidities or recurrent infections.
Safety Profile
Pregnancy avoid
Lactation use-with-caution
Renal Adjustment Not required
Hepatic Adjustment Not required
TDM Not required
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.