Vedolizumab

How it works

It binds the alpha-4 beta-7 integrin on circulating lymphocytes, blocking their adhesion to MAdCAM-1 and reducing trafficking of inflammatory cells specifically into gut tissue.

Prescribing in practice

• Screen for tuberculosis and active infection before starting, and remain alert to infection during treatment despite its gut-selective action.
• Treatment usually begins with an intravenous induction schedule, with maintenance available intravenously or subcutaneously.
• Live vaccines should be avoided and immunisation status reviewed before initiation.

Monitoring

Monitor clinical response to guide continuation and watch for infusion reactions and signs of infection.

Counselling the patient

• Report fever or other signs of infection to your healthcare team.
• This medicine targets inflammation in the bowel rather than acting throughout the whole body.
• Tell your clinician before having any vaccinations.

Evidence & guidelines

NICE recommends vedolizumab as an option for treating moderately-to-severely active ulcerative colitis and Crohn's disease when other treatments have failed or are unsuitable.