Vedolizumab Dose Escalation: In for a Penny, in for a Pound?

Excerpt

Regarding the choices of biologic agents for IBD, as is for all therapeutic interventions, it is often said that the most expensive drug is the one that fails to work. This is probably no truer than in the case of dose-escalated vedolizumab. There exists, therefore, a genuine desire within the IBD community to better understand exactly how effective dose escalation is and in which circumstances it is most likely to succeed. The desire to derive maximal benefit from vedolizumab is borne out of the fact that the number of approved therapies in IBD remains limited and that rates of non-response (primary and secondary) remain significant. For ulcerative colitis (UC) specifically, there are now six approved novel agents encompassing four different mechanisms of action (anti-TNF, anti-IL12/23, anti-integrin, and Janus kinase (JAK) inhibition), a choice far more limited than those available for the treatment of rheumatoid arthritis, for example, which has at least twice as many advanced therapies available. Moreover, failure of medical therapy in UC generally necessitates life-altering surgery, in the form of colectomy and ileostomy formation. It, therefore, stands to reason that IBD clinicians should do everything in their power to extract the most from the currently available range of agents. Marching in lockstep with this aspiration is the necessity for IBD researchers to generate data informing their optimal use. …