Vedolizumab (Entyvio)
Gastrointestinal Agent | Monoclonal Antibody
Black Boxed Warning: Entyvio has a black boxed warning regarding the risk of serious infections, such as tuberculosis and sepsis. Patients should be screened for tuberculosis before starting treatment and monitored for signs of infection during therapy.
Entyvio (vedolizumab) is a monoclonal antibody used primarily for the treatment of ulcerative colitis and Crohn's disease when other treatments have not worked well enough. It specifically targets the α4β7 integrin, thus reducing gut inflammation selectively.
- Selective Mechanism of Action: Entyvio uniquely works by blocking the interaction of α4β7 integrin with MAdCAM-1, primarily affecting gut inflammation without extensively affecting systemic immune responses. This selective mechanism leads to a lower risk of systemic infections compared to other broader immunosuppressants.
- Dosing and Administration: Entyvio is administered via intravenous infusion, initially at 0, 2, and 6 weeks, and then every 8 weeks thereafter. Each infusion session lasts about 30 minutes.
- Monitoring Infusion Reactions: Although infusion reactions are less common with Entyvio than with some other biologics, monitoring during and after infusion for allergic or infusion-related reactions is important.
- Risk of Infections: Patients treated with Entyvio may have an increased risk of developing infections. Pre-screening for tuberculosis and careful monitoring for the appearance of any infectious signs is necessary during treatment.
- Use in Specific Populations: Entyvio has not been studied extensively in pregnant women and should only be used if the potential benefit justifies the potential risk to the fetus. Lactation response is also not well-documented, so decisions should be made carefully considering the drug's necessity.
- Vaccination: Ensure that patients are up-to-date with all their vaccinations before starting treatment with Entyvio as live vaccines should be avoided during treatment and until immune function has recovered.
- Screening for Hepatitis B and C: Similar to other immunosuppressive drugs, patients should be screened for hepatitis B and C due to potential reactivation risks.
- Handling and Storage: The drug should be stored in a refrigerator and protected from light. It should be prepared under aseptic conditions and used soon after preparation if not used immediately.
- Progress Monitoring: Regular assessments of disease activity should be conducted to gauge Entyvio’s effectiveness. If no improvement is seen by week 14 of therapy, consider discontinuing the drug.
- Educating Patients: As with any immunosuppressive therapy, patients should be informed about the signs of infections and other potential side effects. Encourage them to report any symptoms promptly.
Did you find this clinical pearl helpful?
