Vedolizumab for the treatment of inflammatory bowel diseases: from symptomatic control to mucosal healing

Anti-TNF-α have revolutionized the treatment of inflammatory bowel disease, but a significant proportion of patients do not respond or lose response over time after treatment with these drugs. Therefore, the development of drugs that act with a different mechanism of action is strongly needed. Vedolizumab is a selective blocker of intestinal integrin α4β7, which inhibits lymphocyte trafficking and blocks the inflammatory mechanism underlying the bowel damage of Crohn's disease and ulcerative colitis. Clinical trials have shown that vedolizumab is effective and safe for the treatment of inflammatory bowel disease and these data have led to the approval of vedolizumab. However, it remains unclear what therapeutic algorithm to use and which drug to choose as first-line option for patients with moderate-severe disease not responsive to conventional therapies.