Anti-Integrin Monoclonal Antibody (Gut-Selective) Pregnancy: Compatible — low systemic absorption; limited data but gut-selective action suggests lower fetal risk

Vedolizumab

Brand names: Entyvio

Adult dose

Dose: 300 mg IV at 0, 2, 6 weeks, then every 8 weeks. Review response at week 10.

Route: IV infusion (over 30 minutes)

Frequency: Induction: 0, 2, 6 weeks; maintenance: every 8 weeks

Max: 300 mg per dose

For moderate-severe UC and Crohn's. Gut-selective action (anti-α4β7 integrin) — lower systemic immunosuppression than anti-TNF. Preferred in elderly or those with infection risk.

Paediatric dose

Route: N/A

Frequency: N/A

Max: Not licensed in children

No established paediatric dosing; off-label use in specialist paediatric IBD

Dose adjustments

Renal

No dose adjustment required

Hepatic

No dose adjustment required

Clinical pearls

Gut-selective mechanism means lower risk of systemic opportunistic infections vs anti-TNF — preferred in patients with high infection risk, elderly, comorbidities
GEMINI 1 (UC) and GEMINI 2 (CD): clinical remission and endoscopic improvement vs placebo
Slower onset than anti-TNF — may not be first choice for acute severe IBD requiring rapid response
No need for TB screening (gut-selective immune mechanism), but standard infection screening still recommended

Contraindications

Active severe infection
Active TB

Side effects

Nasopharyngitis
Headache
Arthralgia
Nausea
Infusion reactions (less than anti-TNF)
Progressive multifocal leukoencephalopathy (PML) — theoretical risk, reported extremely rarely

Interactions

Live vaccines — avoid
Natalizumab — avoid combination (PML risk theoretical)
Immunomodulators — commonly combined

Monitoring

Stool frequency and rectal bleeding (Mayo score for UC)
Endoscopic assessment at 6–12 months
CRP/faecal calprotectin
Infusion reactions

Reference: BNFc; GEMINI 1 (Feagan et al, NEJM 2013); GEMINI 2 (Sandborn et al, NEJM 2013); BNF; NICE TA342. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways